1. Civil Society in Multilevel
Governance and Global Policy
Structures
Carlos Bruen&RuairíBrugha
Royal College of Surgeons in Ireland
carlosbruen@rcsi.ie

2. NGOs & Global Health Initiatives
• GHIs as global coordinating and multi-level governance mechanisms
– Policies formulated and implemented by networks and partnerships
involving
• Public actors from different decisional levels
• Non-public actors of a diverse nature
• NGO engagement in GHI Formation
– Global Fund
• Advocacy, consultancy with networks and involvement of NGO ‘leaders’ in the
Global Fund Transitional Working Group
– GAVI Alliance
• Limited to small network of NGOs, led by PATH (Program for Appropriate
Technology in Health)
– PEPFAR
• Lobbying and limited consultations with NGO ‘leaders’

3. The Global Fund
Multiple points of entry to
influence policies, priorities
and governance
Decisions taken by
representatives of different
constituencies in processes
involving many of them
• Characterised by
deliberation, bargaining, and
compromise-seeking
• Responsibility disbursed
among a large number of
actors

4. NGOs & the Global Fund: Some Gains
• Increased influence across different sections of the
Global Fund structure
• Increased influence over policy
• Legitimacy enhanced with other constituencies
• Increasing cooperation at global level creating
conditions for:
– Coordination of resources across GHIs
– Cooperation and reduction of ‘warring factions’, e.g.
International Civil Society Support (ICSS)

5. NGOs & Global Fund: Some Challenges
• Undemocratic and anti-participatory processes between global and
country levels
• Divisions and rivalries between NGOs and among broader civil
society groups
• NGOs and broader civil society concerned about donor co-option
• NGOs are increasingly part of the power structures, yet poor
accountability mechanisms in place
– To whom, for what, and how?
• “What is important is to be aware that they are not observers standing on
the sidelines with a watchdog function, figuring out what’s right to do.
They also are similarly interested in finance from the Global Fund. That is
often overlooked I think, and the Civil Society role as advocates and
watchdog and drivers of fairness needs…to be looked at very carefully
– C28, Senior Donor/GHI Representative

6. Multilevel Governance Structures: Accountability
Factors for consideration
• Internal accountability mechanisms perform specific control functions
– Grant oversight, reporting and audits, incl. investigations by the Office of the
Inspector General or similar ‘policing’ mechanisms over finance and results
– NGOs areformally accountable to limited constituencies: to members/rank-
and-file, to donors, to authorities in countries of registration.
– Informal Mutual or Peer accountability mechanisms (e.g. delegation systems)
• Informal monitoring of performance within a network of groups, e.g. reporting on
activities
– Rely on ‘naming and shaming’, withholding resources, restricting access to sanction
– Lack of transparency in peer accountability mechanisms
– Responsibility diluted among a large number of actors allows for blame-shift
games and sanctioning problems
• External accountability mechanisms, e.g. Voluntary Codes of Practice, are
“light” or “soft”
– Not institutionalised and weakly codified, dependent on moral commitments
and social pressure

7. Global Policy Networks: Accountability Factors for
consideration
• Networks prone to:
• Cognitive homogeneity or ‘group think’
– Exclusion of actors whose preferences and priorities do not coincide with the
mainstream ideas of the network at particular times
• Elitism and takeover by more powerful members – network ‘leveraging’
• Difficult to enforce public institution oversight (positive and negative)
• But also offer opportunities for mobilisation and support
• Lengthy chain of delegation makes policy processes visible only to those
who are familiar with them and with resources to engage
• Tends to limit participation of those further away from the final point of
decision-making unless concerted steps are taken to promote active
participation, e.g. GF Community Systems Strengthening framework
• An accountability dilemma – diverse membership must satisfy multiple
stakeholders with different preferences internally and externally to the
network