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Global Health Centre

Challenges of Governing the Global Health Domain

  • Project CoordinatorsIlona Kickbusch, Michaela Told
  • Principal Members: Andrew Cassels, Eleanor Hutchinson
  • Research Assistant:  Austin Liu
  • Project owner: The Global Health Centre at the Graduate Institute of International and Development Studies in Geneva
  • Project status: Ongoing
  • Key Words: Global health, governance, development, reform, diplomacy, global public goods, global policy, health financing, health security, AMR, SDGs, WHO, UN

Over the last 10-15 years, there have been significant changes in governing the global health domain. Beginning with the creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS), dozens of new global health actors emerged ranging from Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to the more recent Global Financing Facility (GFF) in support of Every Woman Every Child. The Bill & Melinda Gates Foundation has emerged as a major donor in global health and the overall development assistance for health has also skyrocketed from USD 11.7 billion in 2000 to USD 35 billion in 2015. The adoption of the Framework Convention for Tobacco Control (FCTC) unlocked the treaty-making power of the World Health Organization (WHO) and the revised International Health Regulations provide an updated framework for global epidemic response. With health issues being discussed more frequently at the United Nations (UN), political clubs and other regional bodies, as well as their increasingly popular engagement with heads of state/government, the global health domain has become infinitely more complex and political.

At the same time there has been a lot of enthusiasm in proposing for governance reform in the global health domain by academic scholars, commission and task forces, governing bodies, or more recently global public policy networks. On one hand there have been suggestions for reforming existing structures including the global health architecture, the UN system and WHO. On the other hand there have been proposals for creating new structures and mechanisms such as a Multi-Stakeholder Platform on Global Governance for Health, an Independent Scientific Monitoring Panel on Global Social and Political Determinants of Health, a Framework Convention on Global Health. Driven by the Ebola outbreak there have also been a range of recommendations for emergency reform such as an Independent Accountability Commission for Disease Outbreak Prevention and Response, a Global Health Committee of the Security Council, or a new Global Vaccine-Development Fund.

This project examines the shifts in governance of the global health domain that have occurred and explores its future directions, especially in strengthening the provision of global public goods in the spirit of the UN Sustainable Development Goals (SDGs) and the emergence of “wicked problems” such as antimicrobial resistance (AMR). It investigates into the emerging political, economic and social dynamics, as well as the changing roles of different stakeholders in the global health domain. In particular, it seeks to highlight the key leadership challenges confronted by the World Health Organization and propose strategic directions for the way forward.

This project is funded by a grant of the Bill & Melinda Gates Foundation.