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Important individuals and agencies in global public health governance
- 1. SLO 2 : Summarize the important individuals or agencies that constitute the governance of public health practices globally MUHAMMAD EMEER EMIRAL BIN SHAHROM (MM2212028T) NIK DEWI DELINA BINTI NIK MOHD KAMIL (MM2212033T) NORSYAHIDA BINTI MD TAIB (MM2212030T) NUR ATIQAH BT IHSAN @ HASNI (MM2212035T) S. MUHAMMAD IZZUDIN RABBANI BIN MOHD ZALI (MM2212031T) 1
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- 3. DEFINITION Global Health refers to ‘those health issues, which transcend national boundaries and governments and call for actions on the global forces and global flows that determine the health of people1 Global Health Governance is defined as “the use of formal and informal institutions, rules, and processes by states, intergovernmental organizations, and non-state actors to deal with challenges to health that require cross-border collective action to address effectively2 1Kickbusch I. The need for a European strategy on global health. Scandinavian Journal of Public Health, 2006; 34: 561–565 2Kheir-Mataria WA, El-Fawal H, Bhuiyan S, Chun S. Global Health Governance and Health Equity in the Context of COVID-19: A Scoping Review. InHealthcare 2022 Mar 15 (Vol. 10, No. 3, p. 540). MDPI. 3
- 4. Kickbusch I, Szabo MM. A New Governance Space for Health. Global Health Action. 2014 Feb 13;7. [Accessed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925805/]. 4
- 5. 6 Organization Governmental or inter-governmental organizations focused on global health include: The United Nations World Health Organization International Agency for Research on Cancer (IARC) WHO Centre for Health Development (WKC) United Nations Children's Fund (UNICEF) UNAIDS The Global Fund The World Bank World Food Programme (WFP) Pan American Health Organization (PAHO) International Committee of the Red Cross Centers for Disease Control and Prevention (CDC) The Global Fund to Fight AIDS, Tuberculosis and Malaria Non-governmental organizations focused on global health include: Médecins Sans Frontières (Doctors Without Borders, MSF) Bill & Melinda Gates Foundation
- 6. 7 The global health initiatives collaborative work in the Region covers several areas: AIDS Tuberculosis and malaria Immunization programmes maternal and child health Tobacco use Human resources Emerging diseases Nutrition Health promotion Health system strengthening. Global Health Initiatives Source: WHO (http://www.emro.who.int/health-topics/global-health-initiative/index.html)
- 7. ORGANIZATION (UNITED NATION ORGANIZATION) World Health Organisation has 6 Core Functions Shaping of research as well as the generation and dissemination of knowledge Setting of norms and standards and the promotion and monitoring of their implementation Production of ethical and evidence-based policy options Provision of technical support and capacity- building Monitoring of health situations and trends. Provision of collective health leadership, World Health Organization website. Available at: http://www.who.int/en/. Last accessed 15/05/16 Kelley PW. Global health: governance and policy development]. Infectious disease clinics of North America. 2011 Jun 30;25(2):435-53. [Available at: https://www.ncbi.nlm.nih.gov/pubmed/21628057] 8
- 8. 9 Global Health Security Agenda The Global Health Security Agenda (GHSA) is "a multilateral, multi-sector effort that includes 60 participating countries and numerous private and public international organizations focused on building up worldwide health security capabilities toward meeting such threats" as the spread of infectious disease. On March 26–28, 2018, the GHSA held a high-level meeting in Tbilisi, Georgia, on biosurveillance of infectious disease threats, "which include such modern-day examples as HIV/AIDS, severe acute respiratory syndrome (SARS), H1N1 influenza, multi-drug resistant tuberculosis — any emerging or reemerging disease that threatens human health and global economic stability."[160] This event brought together GHSA partner countries, contributing countries of Real-Time Surveillance Action Package, and international partner organizations supporting the strengthening of capacities to detect infectious disease threats within the Real-Time Surveillance Action Package and other cross-cutting packages.[161] GHSA works through four main mechanisms of member action, action packages, task forces and international cooperation. In 2015, the Steering Group of the GHSA agreed upon the implementation of their commitments through 11 Action Packages. Action Packages are a commitment by member countries and their partners to work collaboratively towards development and implementation of International Health Regulations (IHR).[162] Action packages are based on GHSA's aim to strengthen national and international capacity to prevent, detect, and respond to infectious disease threats. Each action package consists of five-year targets, measures of progress, desired impacts, country commitments, and list of baseline assessments.[163] The Joint External Evaluation process, derived as part of the IHR Monitoring and Evaluation Framework is an assessment of a country's capacity for responding to public health threats.[162] So far, G7 partners and EU have made a collective commitment to assist 76 countries whereas the US
- 9. Focus of Global Health Initiatives 10 Many debates in the global public health community over o “vertical” approaches focus on treating and preventing a single disease o “horizontal” approaches build health systems that can prevent disease and provide a range of services • More emphasize to be given for holistic approaches Incorporate vertical and horizontal projects Look outward from the health sector to other policy fields such as o Trade o Agriculture o Transport o Environment o Rule of law and social. Source: https://globalhealtheurope.org/opinion-pieces/the-10-challenges-of-global-health-governance/
- 10. 11 Parallel systems undermines holistic approach for health system development Insufficient attention to health inequities, including gender inequities Overworked HCW with expansion of services Weak coordination & Lack of ownership No financial Sustainability Lack of involvement of relevant stakeholders Poor monitoring and evaluation ISSUES OF GLOBAL HEALTH INITIATIVES
- 11. Ex 12 • External funding earmarked for HIV/AIDS control in resource-poor countries: o The Global Fund to Fight AIDS, TB and Malaria o The World Bank Multi-country AIDS Program (MAP) o US President's Emergency Plan for AIDS Relief (PEPFAR) • Rapid scale in HIV/AIDS service delivery • Greater stakeholder participation • Channeling of funds to NGOs and faith-based bodies Positive Effects • Distortion of recipient countries’ national policies * Distracting Governments from coordinated efforts to strengthen health systems and reverticalization of planning, management and evaluation systems Negative Effects Example
- 13. 15 We need a new governance model that takes into account the cosmopolitan ideal of international organizations with universal membership and the realist landscape of populist nationalism among member states. The world faces a clear choice: either take a “my country first” nationalist approach or work cooperatively through shared governance. Innovative global governance arrangements should continue to be tested, evaluated, improved, and when successful be replicated Rigorous research and analysis of the achievements and shortfalls of past experiments in governance arrangements are needed and merit greater attention from the academic community. Leaders of governments, multilateral institutions, civil society organizations, firms, foundations, and other influential actors should identify new governance arrangements that are more effective, equitable, and accountable.
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- 15. REFERENCES • Kickbusch I. The need for a European strategy on global health. Scandinavian Journal of Public Health, 2006; 34: 561–565 • Kheir-Mataria WA, El-Fawal H, Bhuiyan S, Chun S. Global Health Governance and Health Equity in the Context of COVID-19: A Scoping Review. InHealthcare 2022 Mar 15 (Vol. 10, No. 3, p. 540). MDPI. • Kickbusch I, Szabo MM. A New Governance Space for Health. Global Health Action. 2014 Feb 13;7. [Accessed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925805/]. • World Health Organization website. Available at: http://www.who.int/en/. Last accessed 15/05/16 • Kelley PW. Global health: governance and policy development]. Infectious disease clinics of North America. 2011 Jun 30;25(2):435-53. [Available at: https://www.ncbi.nlm.nih.gov/pubmed/21628057] • Labonté, R., & Gagnon, M. L. (2010). Framing health and foreign policy: lessons for global health diplomacy. Globalization and health, 6(1), 14. • Moon, S., Røttingen, J. A., & Frenk, J. (2017). Global public goods for health: weaknesses and opportunities in the global health system. Health Economics, Policy and Law, 12(2), 195-205. • https://link.springer.com/article/10.1007/s40647-018-00250-2 Rethinking Global Health Governance in a Changing World Order for Achieving Sustainable Development: The Role and Potential of the ‘Rising Powers’.2019 17
- 16. THANK YOU 18
Editor's Notes
- Roles of Public Health in Global Health At the end of the seminar, candidates should be able to: 1. Explain the importance of public health towards global health. 2. Summarize the important individuals or agencies that constitute the governance of public health practices globally. 3. Propose recommendations on how the current roles of public health in global health could be improved.
- Kickbusch & Szabo set out the transnational and cross-cutting nature of governance in the global health domain along three political spaces: Global Health Governance, Global Governance for Health, and Governance for Global Health. Global Health Governance refers mainly to organisations and processes of global governance which have explicit health mandates, e.g. World Health Organization Global Governance for Health refers mainly to organisations and processes of global governance which have either a direct and/or indirect health impact, e.g. United Nations, and World Trade Organization Governance for Global Health refers to organisations and mechanisms established at National and/or Regional Level that contribute to Global Health Governance and/or to Governance for Global Health e.g. National and/or Regional Global Health Strategies or Initiatives [3] They suggest that in order to keep global health firmly on the political agenda, and to strengthen action on the determinants of health, reform and strengthening of the governance institutions in all three of these political spheres as well as how they interface is critical.
- A 1988 report entitled The Future of Public Health defined the mission of Public Health as: "fulfilling society's interest in assuring the conditions in which people can be healthy." This mission implies a much broader role for Public Health than simply staffing medical clinics in health department facilities. The Centers for Disease Control and Prevention (CDC) outlines the responsibilities of Public Health in a Community as follows: as above In other words, Public Health sees its "patient" as being the entire community, i.e., the people and the physical and social environments in which they live. Standard indicators such as infant mortality and disease rates are used to measure the health of the community. After assessing the health of the community, Public Health provides leadership for creative problem-solving and policy development. Finally, Public Health continues to monitor the health indicators in the community, assuring that the problems are being addressed and that the "patient" - our community and its people - is becoming healthier.
- Examples of GHIs are the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and the World Bank's Multi-country AIDS Programme (MAP), all of which focus on HIV/AIDS. The Gavi (formerly the GAVI Alliance) focuses on immunization, particularly with respect to child survival.
- The predominant agency associated with global health (and international health) is the World Health Organization (WHO). Other important agencies impacting global health include UNICEF and World Food Programme (WFP). The United Nations system has also played a part with cross-sectoral actions to address global health and its underlying socioeconomic determinants with the declaration of the Millennium Development Goals[11] and the more recent Sustainable Development Goals. SDG 3 (to ensure healthy lives and promote well-being for all at all ages) 3.1. Maternal mortality By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births. 3.2. Neonatal and child mortality By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. 3.3. Infectious diseases By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, and combat hepatitis, waterborne diseases and other communicable diseases. 3.4. Noncommunicable diseases By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment, and promote mental health and well-being. 3.5. Substance abuse Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. 3.6. Road traffic By 2020, halve the number of global deaths and injuries from road traffic accidents.
- it’s about strengthening systems and institutions for delivering health-and that doesn’t just refer to strengthening health systems. It’s about norms and standards, it’s about whole of government approaches and partnerships, it’s far beyond the “North-South” mind-set-there are totally different networks at play-even the infectious/non-infectious disease agenda needs to be framed quite differently.” This broader understanding of global health, demands that global health governance takes responsibility for the determinants of health. The last few years have seen many debates in the global public health community over what are referred to as “vertical” approaches that focus on treating and preventing a single disease, and “horizontal” approaches that try to build health systems that can prevent disease and provide a range of services. Kickbusch is not simply arguing for more horizontal approaches, she is arguing for holistic approaches that incorporate vertical and horizontal projects, but which also look outward from the health sector to other policy fields such as trade, agriculture, transport, environment, rule of law and social justice where many of the determinants of health lie. This means that efforts much stretch beyond building institutions to deliver health care, to institutions and mechanism that can build coherence within health and between health and other sectors. Global health is therefore something larger than the global public health or health in developing countries which people usually think of when discussing global health.
- GHIs have so far paid insufficient attention to health inequities. While increasingly acknowledging equity, including gender equity, as a concern, Initiatives have so far failed to adequately translate this into programmes that address drivers of health inequity, including gender inequities. The review highlights the comparative advantage of individual GHIs, which point to an increased need for, and continued difficulties in, harmonisation of activities at country level. Evidence from a small number of countries suggests that scale-up of HIV/AIDS services is happening; and that it has, to-date, had no impacts (either positive or negative) upon the quantity of other types of health services delivered; - Expansion of services appears to have been achieved by health workers working harder and longer hours, rather than through the addition of more staff but it is unclear what the scope for further enhanced productivity might be; - Two emerging concerns were expressed over sustainability and the balance between treatment, prevention and care and support programmes. Even where governments have maintained their HIV/AIDS spending many countries are now extremely reliant upon donor funding for the continuation of their HIV/AIDS programmes and plans for financial sustainability are not developed. And in some countries it appears that efforts to roll out anti-retroviral therapy may be at the expense of sustaining and developing preventive programmes. incentives for coordination are weak and practice falls far short of policy intent, especially at sub-national levels. •Involvement of all the relevant stakeholders in coordination bodies remains a challenge in many countries, particularly the participation of NGOs. •Harmonisation of donor policies and practices and alignment with national policies has taken place at varying levels across the GHIN research countries. •The coordination of monitoring and evaluation is poor in most countries.
- This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries' national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs.
- Global health governance is at a crossroads Governance challenges will continue to complicate our best efforts to respond to urgent, complex, and serious global health problems. Any effort to strengthen the global health system will require recognition and management of these tensions so that the system can better face the realities of interdependence in the 21st century. Global health is a challenging, complex and uncertain environment Health issues require active involvement of all levels of government (international, national and local) It is important for shared governance for health at all levels which support whole-of government and whole-of-society approaches It must engaged government, NGOs, civil society, private sector, academicians, health professionals, communities and every individual. Therefore partnership must be continuously strengthened.