Evolution of Global Health Landscape – its architecture and governance

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  • Evolution of Global Health Landscape its architecture and governance

  • What is Global Health?Health issues where the determinants circumvent, undermine, or are oblivious to the territorial boundaries of states, and are thus beyond the capacity of individual countries to address through domestic institutions. It focus on people across the whole planet. It recognizes that health is determined by problems, issues and concerns that transcend national boundaries. Global Health involves all partners from government, communities, to foundations, NGOs and private sectors.*

  • Global Health and International Health

    International Global HealthScopeConventional Health Care issuesExtend to Social Determinants of Health, Trade, Climate change, SecurityActorsGovernment health sector technocratsExtend to other sectors, Private Sector, NGOs, GHPs Foundations, AcademiaInfluencing InstrumentsConstitutions, Regulations, ConventionsOther soft laws, financial and trade,Social and intellectual

  • Four major challenges on GH structuresGlobalization freer flow of people, investments, goods and services and information

    Emergence of new actors - especially other sectors, NGOs, private sector and GHPs competing with existing IGOs, even normative functions

    The shifting geopolitical order including the formation of regional bodies and likeminded clubs, e.g. BRICS, FPGH, ASEAN

    Funding structure more donors influences


  • Five metaphors about Global HealthGH as foreign policy trade, democracy, economic growth, image, destabilize countries

    GH as security bioterrorism, pandemic, AMR, MDR, HIV

    GH as charity fight poverty, philanthropy

    GH as investment economic development Medical tourisms, infectious diseases

    GH as public health maximize health effect FCTC, IHR, UC, HR migration, AMR, MDR TB, HIV, etc

  • Global Health Players - not only WHOUN: WHO, ILO, UNICEF, UNFPA, UNAIDs, WTO, WB

    Donors: JICA, USAID n PEPFAR, DFID, EU/EC, G8/G20

    Foundations: BMGF, RF, CMB, Wellcome Trust..

    INGOs: MSF, Oxfam, Clinton foundation..

    Global Health Partnerships: GAVI, GF,

    Private Sector drugs, foods, tobacco, alcoholEmerging MICs more than 100 countries, 5/7 of pop

  • Crowded Global Health Landscape49

  • Who influence Global Health Partnerships Northern Global Actors and private sector?? (analysis of 298 board seats of GHPs)4 (Little contribution but high representation)(so small?)Influence of WHO as compare to private sector and BMGF????(mainly BMGF)11

  • Global Health Financing two decadesGlobal FundThis is only 6% of total national health spending and 26% in low income countriesDirect BilateralUNGF/GAVI

  • *WHO budget: assessed and voluntary contribution 1998-2013

  • Top ten WHO donors (voluntary contribution) 2010-2011*

    DonorsNon earmarked%Earmarked%Total1. Gates0 0% 446,161,801 100% 446,161,801 2. USA 0 0% 438,285,683 100%438,285,683 3. UK 41,009,718 14% 247,942,675 86% 288,952,393 4. Canada00% 154,147,294 100% 154,147,294 5. Rotary 00% 116,565,898 100% 116,565,898 6. Norway 47,925,896 42% 65,963,666 58% 113,889,562 7. UNDP00% 109,890,218 100%109,890,218 8. GAVI00% 98,782,852 100% 98,782,852 9. Australia 28,717,115 31% 63,097,757 69%91,814,872 10. UN CERF00% 90,809,419 100% 90,809,419

  • StrengthsSocial Credit as Global Normative BodiesUnlimited access to the best global expertsExtensive networks of WHO Regional and WROSOnly legitimate body for PHEIC (like Ebola)WeaknessesBureaucratic Systems vertically and inefficientIncreasingly politicizedOutdated regional structuresChanging budgetary structures Loss of global PH spirits loss of good people12Strengths and Weaknesses of WHO

  • Concrete examples Brazil appoints their Chief of Global Relation in the MoPH from DDG level of the MFA

    SA has two health attache one in DC and the other in Geneva

    Most developed countries has health attache in many strategic countries

    Many donors now have Health Ambassadors and also Global Health Policies/Strategies, division in MFA