Civil Society Organizations and Global Health Governance
Papers
Kenneth W. Abbott
Innovations in Global Health and the Global Governance System
Abstract:
The growing role of civil society in global health governance reflects profound and well-known changes in the overall system of global governance. In many respects, however, health governance is actually leading those changes. This paper uses the lens of Liberal international relations theory to explore innovations in global health governance that are not only interesting and significant in their own right, but are also of broader importance for global governance. These include (1) the role of civil society organizations (CSOs) as “proponents” or advocates of policy and the advocacy partnerships formed by CSOs and public organizations; (2) the changing nature of inter-state regimes, such as the WHO/international health regime, due to the growing participation of domestic, non-state actors; (3) the strategies of organizations like the Global Fund to Fight HIV/AIDS, TB and Malaria to engage with and empower domestic CSOs in dealings with their own governments; and (4) the emerging role of CSOs, private sector firms and other non-state actors as “protagonists” or direct participants in international governance, independently or in collaboration with states and international organizations. The paper uses the Governance Triangle to map and analyze the forms and patterns of private and private-public governance arrangements.
Sonja Bartsch
Global Public-Private Partnerships in Health: A Question of Accountability and Legitimacy
Abstract:
This paper deals with the accountability of global public-private partnerships (GPPPs) in health and their legitimacy as actors of global health governance. It consists of a theoretical part in which the most important characteristics of the two concepts and the specifics of partnership accountability are discussed, and an empirical part in which the current landscape of global health partnerships is scrutinized. It is argued in the first part that accountability relationships of partnerships differ from those of other actors, as the multi-actor constellation of GPPPs complicates both the identification of the agent and its control through the principals. In order to create accountability adequate mechanisms in three core dimensions – information, participation, and sanctions – are required. In the second part of the paper different types of health GPPPs are investigated with regard to their performance in these three dimensions. It is shown that the degree of accountability differs considerably between advocacy, research & development, service support, and finance partnerships. Limited accountability, however, can undermine the legitimacy of GPPPs as actors of global governance processes and core requirements should be met to improve the current architecture of global health.
Nick Drager et al.
The Cutting Edge of Global Health Diplomacy: Foreign Policy, Trade and Health
Abstract:
The interdependence produced by globalization has broken down traditional ways of conceptualizing and organizing the medical, economic, political and technological means to improve health. Nowhere is this transformation more apparent than in the rise of health as a foreign policy and trade concern. This relationship between health, foreign policy and trade is vital, complex and debated. To craft health policy today, governments, international institutions and nongovernmental organizations must find mechanisms to manage health risks that spill into and out of every country. These endeavors have created the new world of global health diplomacy. Global health diplomacy brings together the disciplines of public health, international affairs, management, law and economics and focuses on negotiations that shape and manage the global policy environment for health. This paper focuses on this new era of global health diplomacy by exploring the relationship between foreign policy, health and trade. It illustrates this nexus with three examples of negotiations where foreign policy, trade and health interests intersect. It concludes with some thoughts on directions for the future if we are to insure that global health diplomacy leads to good public health outcomes. A strong effort by all interested public and private stakeholders to pursue outward-looking diplomacy will be critical to insure good public health outcomes in future negotiations. Initiatives that seek to support collective action for the global public good, to frame the issues from a global public good perspective and to promote the public health values of universalism, justice, dignity and human rights will be of key importance.
Kelley Lee
The Role of CSOs in Intergovernmental Health Organisations: Contributions to Global Health Governance
Abstract:
There has been growing discussion of how GHG should and could be strengthened, including consideration of the potential role of civil society organisations (CSOs). In recent years, the largely positive view of CSOs has given way to more critical reflection of: (a) the governance of CSOs themselves; (b) the role of CSOs in current GHG; and (c) the transformation potential of CSOs to strengthen GHG in future. This paper considers the role of CSOs in intergovernmental health organisations (IGOs), and maps the specific governance functions carried out by CSOs in four selected health governance instruments which are formally under the auspices of IGOs – the International Code on the Marketing of Breastmilk Substitutes, Framework Convention on Tobacco Control, International Health Regulations and Codex Alimentarius. For each, the paper assesses the effectiveness and appropriateness of CSOs involvement, and draws conclusions about the opportunities and limitations CSOs represent for strengthening GHG.
David McCoy and Margaret Hilson
Civil Society, Civil Society Organizations and the Governance of Health at the Global Level
Abstract:
This paper examines the rapid emergence of the concept global civil society and civil society organizations over the past century. Their role is catalyzing social progress has been critical to the struggle for the anti-slavery movement, female emancipation, the civil rights movement and the struggle against apartheid are just some examples of their growing political power throughout the world. The first section of this paper presents observations about civil society, global health governance and the heterogeneity of civil society organizations that lend voice to concerns and aspirations of communities and social movements. However, in expanding democratic spaces for civil society voices, challenges and opportunities are faced in determining legitimacy and representivity. In the second section specific examples of experiences between UN agencies and civil society organizations are described. There is recognition of the value of increased and effective civil society involvement in world ive. Dr. Narayan was a national joint convener of the Jan Swastya Abhyan (People’s Health Movement India) ont class="name">Til 2007.
Abstract:
It is an example of country level civil society analysis and action with regard to health and health policy from an equity perspective. Dr. Narayan was a national joint convener of the Jan Swastya Abhyan (People’s Health Movement India) from 2003 till April 2007.
Paul Shaw
The Interface between CSOs and the World Bank; An Input to Global Health or Global Harm?
Abstract:
This paper begins with a brief overview of the evolution of World Bank (WB) lending on health, nutrition and population (HNP), its involvement in global health programs and global health governance. It then describes four priorities in the WBs business and operating model that condition its approach to development in general and the health in particular. This sets the stage for a more informed look at the institutional interface between CSOs and the WB, including four CSO “pressure points” that appear to have impacted on the WBs business model. The importance of each of these pressure points for the WB, development in general, and HNP are illustrated. The paper concludes with a few reflections on ways in which the WB might best serve global health and global health advocacy in the future. Issues for discussion and possible debate arising from the paper include; How should the WB establish its proper place in the huge menu of possible goals and ends of
global health governance? To what extent should the WB continue to focus on countries and improving national health systems in poor countries as critical inputs to better health governance? To what extent should the WBs comparative advantage in public finance be stressed as a
component of better health and global health governance, while resisting “mission creep” to do seemingly everything? What more can the WB do to accommodate legitimate complaints of ‘watch dog’ CSOs? How can CSOs, big and small, make better use of the WB as an agent of global health
development, advocacy and governance?
Mark W. Zacher and Tania J. Keefe
The Transformation of Global Health Governance: Utilization and Expansion of Control Strategies since the 1990s
Abstract:
The paper analyses the transformation of global health governance that has occurred since the early 1990s. It identifies and explains three strategies that have been central to recent changes in the health regime. These strategies are: surveillance of disease outbreaks; rule-making (including issuing recommendations); and providing financial and material assistance to improve health conditions. The changes have been particularly dramatic with regard to surveillance and assistance, and in both of these spheres civil society organizations (CSOs) been instrumental. CSOs have had major impacts on surveillance because of the revolution in information technology that has made it difficult for governments to stymie the flow of information from their territories. CSOs have been central to the dramatic increase in assistance efforts because of their ability to mobilize financial resources and their experience in working directly with victims of disease. CSOs have also made significant contributions to rule-making through the expertise of their medical specialists, their mobilization of financial resources, and their leverage that derives from their political pressure in national and international settings.