Fixing the weakest link in global health governance

References to 'global health governance' have become increasingly popular. Many universities are following the trend. Some are pursuing the option of providing masters and other tailored training courses that reflect the growing importance of the links between globalisation and health and the nexus between the two.

World Health Assembly

Many world leaders have also recognized the need to pay particular attention to common health risks. When United States President Barack Obama and African leaders met in August 2014 in Washington, DC, at the first Africa-US Leaders Summit, they recognised the challenges posed by common health threats. They all looked forward to the creation of an African Centre for Disease Control and Prevention. Even leaders of the security-oriented North Atlantic Treaty Organization (NATO), when they met in Wales in September 2014, included health risks as elements that could torpedo military planning in their operations around the world.

The UN Security Council too has been conducting meetings over the past weeks to address the current Ebola outbreak as a threat to international peace and security. It is important that such attention is placed on health at the very highest levels of government. The intensity of the cooperation between the World Health Organization (WHO) and individual African countries in the current Ebola crisis has again revealed how health threats cannot be quarantined and dealt with within national boundaries alone.

There is no question that national and global levels of governance are vital in dealing with these common health problems. However, a critical vacuum remains regarding what happens at the regional level that intermediates between national and global health responses.

The role of cross-border regional structures and initiatives in confronting health risks cannot be underestimated. The creation of robust regional health warning systems can help to alert countries of the risk of viruses and assist them in shaping and coordinating individual reactions. Common regional health initiatives including twinning/partnering of referral hospitals and laboratories can help scale the sharing of vital data needed to predict and avert epidemics and pandemics while also scaling and optimizing scarce resources.

What is more, joint and coordinated procurement of medicines, vaccines and also diagnostic/ preventive kits can be more beneficial than individually negotiated deals.

This is so because of the price benefits associated with scaling bulk demand.

In spite of these advantages, the importance placed on regional level health response remains limited and consistently inadequate. Beyond the European Union and, to an extent, the Union of South American Nations (UNASUR) and the Southern African Development Community (SADC), performance of regional organizations in the area of health is timid, at best.

Failure to amply address this gap will lead to aggravated uncoordinated responses in addressing critical health threats. It is arguable that various national governments and WHO itself are the needed levels of response. As such, some may regard the regional level as an unnecessary onerous bureaucratic burden in the chain of health governance. This may be so, given the linear and direct channels of communication between WHO and its various member states. Yet even WHO itself recognizes the need for complementary regional responses to its global health challenges. That is why it has specific regional offices that provide services tailored to the needs to given regions.

Global health governance will be strengthened if the various national governments and stakeholders, as well as WHO, increase partnerships with regional organisations. How can this be done? There is need for greater cooperation and exchange of information between WHO's regional offices and respective relevant regional organisations that have a mandate in the areas of health promotion and health governance.

Related to this is the need for periodic results-oriented activities between heads of relevant regional organisations and the head of WHO. This could take the format of or be aligned to the periodic meetings held between the United Nations Secretary General and leaders of regional arrangements and agencies whose mandates include security amongst others.

Widening the participatory space within the World Health Assembly for these entities to become observers, as is the European Union (EU), would also be useful and highly salutary.

Further, it is vital that regional organisations that are mainly composed of least developed countries make full use of the flexibilities built into the World Trade Organisation's Agreement on Trade Related Aspects of Intellectual Property (TRIPS). WTO decisions/declarations and TRIPS amendments have made this possible. Yet countries have underused it.

A case could also be made that stringent conditions in using these flexibilities need to be relaxed as they are currently replete with protracted red tape. WHO has conducted work through its special working groups exploring how TRIPS flexibilities can be maximized in accessing affordable medicines. The importance and relevance of this work needs to be felt as well at the regional level through the work of the regional offices of WHO in their engagements with relevant regional outfits.

Linked to the preceding, it is vital that regional organisations establish channels that connect their activities with regional intellectual property organisations to maximise joint procurements and use of collective licenses in terms of obtaining affordable medicines and vaccines.

In addition, for regional entities to be taken more seriously, they really need to show what they can bring to the table. What are they doing to promote collective action on research and development in the biomedical field? What are they doing concretely through adoption and implementation of initiatives akin to the former Framework Programs and current Horizon 2020 plans of the EU?

This is really where the rubber hits the road. Regional outfits with health mandates can scale their limited budgets (even through partnership with the private sector and foundations) to explore ways of supporting local/regional cooperation between researchers and research institutes that work on common health problems.

Finally, regional organizations with a mandate in health need dynamic evaluation and monitoring tools that properly link up global resources and local/national realities. Here is where the important initiative we work with, funded by the Economic and Social Research Council of the United Kingdom (UK), comes in.

The initiative looks at the connections between poverty reduction and regional integration (PRARI) with a focus on pro-poor health policies that mainly confront the needs of the most vulnerable in societies, especially in the post-2015 context as countries and international institutions debate ways of securing optimal financing for development. The PRARI initiative explores ways in which regional institutions can partner with both local and global outfits to map out a canvas of indicators, which are usable by regional policy makers and practitioners to monitor key health results and trends.

International experts involved in the project are pulled from the Open University (UK), the University of Southampton, the United Nations University Institute on Comparative Regional Integration Studies (UNU-CRIS), FLACSO Argentina and the South African Institute of International Affairs. The approach used is heavily participative with a sharpened intensity on the input from those in the regional bodies (mainly SADC and UNASUR) that would use the toolkit of indicators developed to gauge effectiveness of regional pro-poor health policies in Bolivia, Paraguay, Swaziland and Zambia.

Better integration of regional contributions to the global health institutional architecture is worthwhile. But realising this goal will not be thorn-free.

The risks are that there is a danger of inflated and unpredictable costs for expanding bureaucracies and of adding more layers to an already complex tapestry of institutional responses. However, in the unique area of health where many viruses and germs defy border controls, more communication and coordination across the national, regional and global levels of governance would strengthen global health governance.

- Our World