The Bill and Melinda Gates Foundation, which spends billions on global health, is taking a direct route to ensuring global health coverage for all. NewsHour with Jim Lehrer in the United States received a Gates Foundation grant of US$3.5 million to help its correspondents produce 40 to 50 reports over three years on malaria, AIDS, tuberculosis, measles, neglected diseases and other global health issues. It came with ‘no strings’, reported the managing producer of NewsHour, which is seen on 315 PBS stations, noting that, if her reporters found a story critical of the Foundation’s work and Mr Gates objected, she’d let him defend it, of course, but was still determined to proceed with the story.
Governance and participation in health
Gates Foundation gives millions for coverage of world health
McNeil DG: New York Times, 8 December 2008
GDN-AERC workshop on institutional capacity strengthening
Kenya: September 2009
The Global Development Network (GDN) and the African Economic Research Consortium (AERC) jointly organised a workshop for their United Nations Development Programme-funded project in Cape Town, South Africa, on 7–8 May 2009: Institutional Capacity Strengthening of African Public Policy Institutes to Support Inclusive Growth and the Millennium Development Goals. This was the third event for the project, following the workshop in Kuwait (February 2009) and the initial planning meeting held in Accra (June 2008). The objective of the project is to provide support to enhance knowledge management capacity for African Policy Research Institutes and networks with a particular focus on tackling the issues of poverty and hunger within the global Millennium Development Goals framework. It will seek to strengthen multi-disciplinary research capacity on poverty analysis and contribute to bridging the gap between research and policy on poverty reduction and sustainable development. Papers from the workshop are expected to be finalised by the end of July 2009. Policy briefs, based on the final papers, will be produced by the relevant institutions. The group also chalked out a dissemination strategy for the project. A concluding workshop has been scheduled for Kenya, in September 2009.
Gendered norms of responsibility: reflections on accountability politics in maternal health care in Malawi
Lodenstein E; Pedersen K; Botha K; et al: International Journal for Equity in Health 17(131) 1-15, 2018
This paper aims to provide insights into the role of traditional authorities in two maternal health programmes in Northern Malawi. Among strategies to improve maternal health, these authorities issue by-laws that are local rules to increase the uptake of antenatal and delivery care. The study uses a framework of gendered institutions to critically assess the by-law content, process and effects and to understand how responsibilities and accountabilities are constructed, negotiated and reversed, in a qualitative study in five health centre catchment areas in Northern Malawi. In the study district, traditional leaders introduced three by-laws that oblige pregnant women to attend antenatal care; bring their husbands along and; and to give birth in a health centre. If women fail to comply with these rules, they risk being fined or denied access to maternal health services. The findings show that responsibilities and accountabilities are negotiated and that by-laws are not uniformly applied. Whereas local officials support the by-laws, lower level health cadres’ and some community members contest them, in particular, the principles of individual responsibility and universality. The study adds new evidence on the understudied phenomenon of by-laws. From a gender perspective, the by-laws are problematic as they individualise the responsibility for maternal health care and discriminate against women in the definition and application of sanctions. Through the by-laws, supported by national policies and international institutions, the authors argue that women bear the full responsibility for failures in maternal health care, suggesting a form of ‘reversed accountability’ of women towards global maternal health goals. This can negatively impact on women’s reproductive health rights and obstruct ambitions to achieve gender inequality and health equity. It is suggested that contextualised gender and power analysis in health policymaking and programming as well as in accountability reforms could help to identify these challenges and potential unintended effects.
Global health diplomacy: A way forward in international affairs
Report of the Inaugural Conference of the Global Health Diplomacy Network: Chatham House, 2011
The Inaugural Conference of the Global Health Diplomacy Network was held on 28 June 2011 in London, United Kingdom. More than 190 diplomats, health professionals, senior government officials, academics, and representatives of business and non-governmental organisations gathered to discuss contemporary issues in global health diplomacy and outlooks for the future of the Network. After the presentations were held, the Network made a number of resolutions, concluding that the Network should help the health sector understand that the top priorities of foreign policy are national security and economic growth, not health. The health sector must not view the link between health and foreign policy as an opportunity to exploit the foreign policy sector to reach health goals. Instead, it must think how it can advance foreign policy goals and be aware and acknowledge that health policy can have a positive or negative impact on foreign policy and its goals, just as foreign policy can have positive or negative impacts on health. Participants acknowledged that much health diplomacy in Geneva focuses on trade and about intellectual property issues, while there is a wider lack of coherence across the different global institutions and their goals, a problem which has been exacerbated by the proliferation of global actors.
Global health diplomacy: An emerging field
Akukwe C: The African Executive, June 2010
In this article, the author briefly examines various definitions of ‘global health diplomacy’ (GHD), reviews possible fundamental principles and discusses unresolved challenges. He argues that fundamental principles of GHD should include: ethical participation and decision making; human rights concerns and enforcements; rule of law and clear process for settling disputes; social determinants of health and how to mitigate their impact; shared bilateral and international interests and priorities; centrality of target populations and sensitivities to local customs, religions and social mores; research as part of efforts to expand the frontiers of the field; training and field experience for all practitioners; an understanding of political, policy making, advocacy and implementation issues in global health; globalisation and international trade issues; integration and mainstreaming of policies and programmes in the relationship between global health, bilateral diplomacy and multilateral development; and public/private/civil society partnerships and alliances. He identifies five challenges for GHD. The first challenge is to further develop the field of GHD as a discipline. The second challenge is how to harmonise the divergent orientation of public health experts, trained diplomats and development experts. Thirdly, stakeholders must ensure that global health diplomacy retains a significant focus on the needs of target populations around the world. Finally, stakeholders must find strategies to maintain the current non-partisan support of policy makers on global health issues over the long term.
Global health governance as shared health governance
Ruger JP: Journal of Epidemiology and Community Health (2011), 14 December 2011
The author of this article develops select components of an alternative model of shared health governance (SHG), which aims to provide a ‘road map,’ ‘focal points’ and ‘the glue’ among various global health actors to better effectuate cooperation on universal ethical principles for an alternative global health equilibrium. Key features of SHG include public moral norms as shared authoritative standards; ethical commitments, shared goals and role allocation; shared sovereignty and constitutional commitments; legitimacy and accountability; country-level attention to international health relations. A framework of social agreement based on ‘overlapping consensus’ is contrasted against one based on self-interested political bargaining. A global health constitution delineating duties and obligations of global health actors and a global institute of health and medicine for holding actors responsible are proposed. Indicators for empirical assessment of select SHG principles are described. The author concludes that global health actors, including states, must work together to correct and avert global health injustices through a framework of SHG based on shared ethical commitments.
Global health governance as shared health governance
Ruger JP: Journal of Epidemiology and Community Health (2011), 14 December 2011
The author of this paper develops select components of an alternative model of shared health governance (SHG), which aims to provide a ‘road map,’ ‘focal points’ and ‘the glue’ among various global health actors to better effectuate cooperation on universal ethical principles for an alternative global health equilibrium. Key features of SHG include public moral norms as shared authoritative standards; ethical commitments, shared goals and role allocation; shared sovereignty and constitutional commitments; legitimacy and accountability; country-level attention to international health relations. A framework of social agreement based on ‘overlapping consensus’ is contrasted against one based on self-interested political bargaining. A global health constitution delineating duties and obligations of global health actors and a global institute of health and medicine for holding actors responsible are proposed. Indicators for empirical assessment of select SHG principles are described. The author concludes that global health actors, including states, must work together to correct and avert global health injustices through a framework of SHG based on shared ethical commitments.
Global health security: the wider lessons from the west African Ebola virus disease epidemic
Heymann D et al (23 co-authors): The Lancet 385 (9980),1884–1901, 2015
The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. It drew renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? This paper describes some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed but their common goal is a more sustainable and resilient society for human health and wellbeing.
Governance and corruption in public health care systems
Equidad listserv : PAHO
"What factors affect health care delivery in the developing world? Anecdotal evidence of lives cut tragically short and the loss of productivity due to avoidable diseases is an area of salient concern in global health and international development. This working paper looks at factual evidence to describe the main challenges facing health care delivery in developing countries, including absenteeism, corruption, informal payments, and mismanagement. The author concludes that good governance is important in ensuring effective health care delivery, and that returns to investments in health are low where governance issues are not addressed." (Author's abstract)
Governance and Equity-oriented Policies for Urban Health
Shakim C: ECSA HC Best Practices Forum, Arusha, Tanzania, 2018
This presentation given at the ECSA HC Best Practices Forum 2018 provides an overview of urban poverty and global commitments to equity oriented policies for urban health; urban health challenges in Sub-Saharan Africa; examples of how youth and community engagement could inform change and how to support the development of governance and equity oriented policies. The author notes that unmanaged urban growth is linked with rising social and economic inequities that benefit the well off and negatively impact health and well-being of the poor and disadvantaged; and that densely packed areas with low levels of sanitation services offer a petri dish for infectious diseases. This contributes to higher cost of living, high risk of school dropout and teenage pregnancy and high rates of crime and violence. Shakim provides evidence of youth as agents of change in urban Tanzania through the Tandale Health Centre.