GLOBAL HEALTH GOVERNANCE
Until the 1990s, nation-states and multilateral organizations with state members governed international health. Health funding was mainly bilateral, flowing between donor and recipient governments. National ministries shouldered responsibility for health services delivery. Acceleration of globalization, increasing economic interdependence, and vast international movements of people and products ushered in the Global Health Governance (GHG) era. Recognizing that infectious diseases emerging or re-emerging somewhere can have repercussions everywhere gave new urgency to addressing health on a global scale. GHG is dramatically more complex than International Health Governance (IHG), with a plethora of new actors and the accompanying deluge of uncoordinated activities, and only recently has a definition of “global health” been attempted. Today one, of the most salient issues remains the lack of coordination among donors and between donors and recipient governments; GHG’s proliferation of actors and initiatives has exacerbated this problem. Main approaches to health challenges are vertical and horizontal, trending into calls for a diagonal third way. Vertical programs or selective primary health care are disease-specific, while horizontal programs or comprehensive primary health care entail broad-based development and strengthening of health systems without particular specification of health priorities. A consensus is growing around the need for more action on health systems strengthening, which is more and more considered key to improving health. Despite select “proven successes in global health,” overall, the state of global health governance reflected by the literature points to continuing, decades-old problems of insufficient coordination, the pursuit of national and organizational self-interest, inadequate participation by the recipients and targets of aid, and sheer lack of resources. The world needs a new way forward, and shared health governance (SHG) may provide a useful conceptual and operative framework.
