Global health centre
21 September 2016

How to make the global health governance system fit for the 21st century?

On 16 September 2016, the Global Health Centre, in collaboration with the Global Policy Institute of Durham University, held the first Policy Dialogue Workshop on the SNIS-funded research project on “How to Break the Gridlock in Global Health Governance” to discuss whether a failure in global health governance exists or not; and if mechanisms can be identified which lead to successful governance solutions and therefore can inform future reform strategies. 26 participants representing UN agencies, governments, academia and NGOs discussed the gridlock theory and its relevance to health.

The landscape of global health changed dramatically in the last two decades, and it appears that significant progress and breakthroughs in global health governance have occurred in this relatively short period of time but also left a number of issues unaddressed: The three health-related Millennium Development Goals (MDGs) have remained largely unmet, especially in low- and middle-income countries, and the emergence of new (and often unprecedented) health threats, poses troubling questions of whether the global health system is capable to deal with the ever increasing interconnectedness and complexity of global health issues.

In this context, a central question is how to make the global health system fit for the 21st century and what role governance can and should play to resolve health problems.

Global health governance has witnessed a significant degree of institutional innovation and political agency, both within and beyond the World Health Organization (WHO) and other multilateral agencies. In fact, WHO has demonstrated its capability to learn as an organisation, especially in the aftermath of health crises, such as SARS, H1N1, and Ebola.

These positive developments were characterised by cosmopolitan moments which opened windows of opportunity for reform but left the structural weaknesses of the health governance architecture, such as lack of coordination between actors, inability to keep predictable funding commitments, and inertia in emergency response, unaddressed. In other words, while the results achieved in the post-1990 global health landscape cannot be dismissed, the possibility of identifying pathways to gridlock in global health governance certainly represents a critical alarm bell for a system which is called upon to deliver on the targets set by Sustainable Development Goal 3 while dealing with the daunting task of tackling the broader determinants of health in an increasingly interconnected world.

The High-level meeting on antimicrobial resistance (AMR), held on the 21 September in New York at the 71st session of the United Nations General Assembly, produced a strong political declaration underlining the importance of global health and its implications for national and international security, economic well-being, and economic and social development. Therefore, the shift of global health from a sectorial issue to a topic discussed in the highest spheres of politics and governments, constitutes not only an opportunity but also a challenge for the global health governance system: it creates the conditions for mobilising action, but also requires multi-sectorial approaches, better coordination among actors, and increased institutional flexibility to function.

This first Policy Dialogue Workshop allowed practitioners to share their perspectives on the current global health governance architecture, on its successes and failures. The research project is analysing the governance of HIV/AIDS, Ebola and AMR, investigating institutional changes and political responses to these health issues. It explores the relevance of the gridlock theory for health and identifies the parameters which determine such gridlock or allow it to be overcome. Prof Ilona Kickbusch, Dr Michaela Told and Dario Piselli from the Global Health Centre are involved in this research project that started in October 2015 and is expected to last for two years.

Photo: Perry G