Global Health Risk Framework Governance for Global Health: Workshop Summary (2016) / Chapter Skim
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7 Comparing Hypothetical Models of Governance for Global Health
7 Comparing Hypothetical Models of Governance for Global Health
Pages 83-104
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From page 83... ...
• Responsibility at the country level to build health capacity needs to be shifted back to member states from WHO and the international and regional levels. Improvement at the country 83
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From page 84... ...
WHO's performance during the Ebola crisis -- although it unfolded after the Chatham House report was prepared -- highlighted problems in its organizational structure, governance, and culture. He thought that WHO's role in disease outbreaks should not be examined in isolation from its normative functions, but instead urged the audience to consider how much of WHO's resources should be devoted to outbreak response.
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From page 85... ...
The first involved the insulation of WHO's technical work from its political interests, based on the assumption that the excessive intrusion of political considerations in WHO's technical work damages WHO's credibility. To meet this challenge, the Chatham House panel advised that WHO should provide for a clear distinction between its technical departments and those dealing with governance by appointing a Deputy Director-General with responsibility for technical work and its integrity, akin to the role played by Chief Scientists in UK government departments.
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From page 86... ...
Thus, he said, a bargain must be made in which the states encourage more courageous reform actions on the part of the organization, while also offering the incentive of more stable funding for WHO's core functions, including outbreak response. MODEL 2: WHO PLUS As Stocking had previously described, the Ebola Interim Assessment Panel she chaired proposed the creation of a center for humanitarian and outbreak management attached to WHO and under authority of the Director-General that combined strategic, operational, and tactical func 3 This was suggested by WHO's Executive Board in 1997, and subsequently in external reports from the joint intelligence unit of the United Nations and other evaluators, but was never undertaken, Clift pointed out.
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From page 87... ...
The first and foremost of these was the declaration by WHO's member states that the responsibility for health security rests with the organization, which should be strengthened to fulfill this core function. While differing from the Chatham House panel in the suggestion not to separate the technical and political functions of WHO, the Ebola Interim Assessment Panel felt both elements needed to be better managed at the level of the member states, as well as within the secretariat, Kickbusch stated.
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From page 88... ...
MODEL 3: AN EXECUTIVE AGENCY "The executive agency model is activated only when a multisectoral global response is required to reduce health risk. This allows the UN system to create an enabling environment in which WHO takes the lead in the health sector or cluster." -- Yasushi Katsuma, Waseda University, Japan
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From page 89... ...
As Gostin noted, this model aims to take advantage of WHO's expertise and legitimacy, while tapping into the UN's higher-level political authority and support. To provide context for the executive agency model, Katsuma described a typology of health risk as a matrix defined by two variables: infectious diseases that are either known or unknown, and national capacities and accountabilities for outbreak response that are high, low, or fragile (see Figure 7-1)
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From page 90... ...
, with WHO taking the lead in the Health Cluster. The proposed executive agency model is activated only when a multisectoral global response is required to reduce health risk, as in Type 3 and Type 4, Katsuma stated.
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From page 91... ...
could be a recipient of the possible World Bank pandemic emergency facility, as previously discussed. The regional response to a Type 4 health risk, according to the executive agency model, would harmonize the regional health organization and the regional office of UN programs and funds -- a process that Katsuma described as practically necessary, but politically difficult, due to the mismatch between WHO's regions and those of the UN humanitarian system.
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From page 92... ...
Therefore, it may be necessary during a health emergency for the UN to replace an incumbent resident coordinator with a humanitarian coordinator who is better prepared to lead in a complex health humanitarian situation, he said. MODEL 4: A SEPARATE AGENCY "The real question I think we need to pose is whether it's a governance issue requiring a new entity -- or if it's a problem of systems coherence, a problem of leadership at all levels, and a problem of coordinating the existing infrastructure and arrangements." -- Daniel López-Acuña, Former WHO Senior Adviser to the Director-General The final model envisions an independent, interagency entity for global health risk governance, under the authority of the UN Secretary-General.
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From page 93... ...
The current system may not function perfectly, but he urged attention to the breadth and depth of existing mechanisms and agencies involved in global health risk governance. Going further, López-Acuña stated bluntly that the current system lacks coherence, consisting of three parallel tracks.
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From page 94... ...
The WHO constitution defines several functions relevant to governance for global health risk, as noted by López-Acuña. Per Article 2, WHO • Directs and coordinates authority of international health work; • Establishes and maintains collaboration with the United Nations, specialized agencies, governmental health administrations, profes sional associations, and other groups as deemed necessary; • Assists governments, upon request, in strengthening health services; • Furnishes appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of governments; • Stimulates and advances work to erradicate epidemic, endemic, and other diseases; and • Proposes conventions, agreements, and regulations (WHO, 1948)
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From page 95... ...
In leading the Health Cluster, WHO works with more than 50 UN agencies and NGOs to organize and coordinate the health response to an activating crisis. But despite the existence of this extensive health and humanitarian architecture, Ebola in West Africa became a humanitarian emergency and a global health risk, López-Acuña observed.
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From page 96... ...
NOTE: ERC = Emergency Relief Coordinator; HC = Humanitarian Coordinator (OCHA) ; NGO = nongovernmental organization; RC = Resident Coordinator (OCHA)
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From page 97... ...
The global architecture is already crowded, he pointed out, and the creation of new entities contradicts the course the United Nations has taken to reform and streamline, guided by the recent Sustainable Development Goals. Most of the capacities and functions needed to address global health risk governance -- and many of the mandates to do so -- lie within the purview of WHO, López-Acuña argued.
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From page 98... ...
He noted that several robust, pragmatic solutions had already been raised in the few days of discussion. Finally, Shibuya suggested that designers of the framework for global health risk governance could learn valuable lessons from other sectors, such as finance and cybersecurity.
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From page 99... ...
This approach is equally applicable to pre paredness and response; linking health security and the universal health care agenda, and thereby gaining the trust of communities, is essential for effective response to global health threats, he declared.
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From page 100... ...
"The key questions are how to better coordinate the different global and regional or national actors, including within institutions themselves, and in particular how to handle the challenge of multisectorality." 5. A strengthened WHO at the helm of global health risk governance must make better use of the UN system's assets and resources, such as the existing humanitarian emergency response system and the cluster system, and bridge the deep cultural differences between those who work on disease outbreaks and those who tradition ally work on humanitarian emergencies, Rasanathan stated.
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From page 101... ...
, Kickbusch suggested that the WHO Director-General and the governing bodies of the United Nations could jointly appoint the board -- much as they did the Ebola Interim Assessment Panel -- and charge them with delivering an independent report. Any such body would be informing the United Nations, as well as reflecting on the WHO member states, she pointed out.
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From page 102... ...
However, he acknowledged, many details of Model 2 remain to be resolved: funding, the member states' inclination to change WHO's governance structures, and -- given criticisms of UNMEER -- linkage with the broader UN system. Looking beyond WHO reform and IHR compliance, Elias urged attention to opportunities for improving global health governance through more effective engagement with the private sector, civil society actors, and foundations.
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From page 103... ...
Unfortunately, he added, there is little financial support to encourage such citizen activism "because lots of people, including donors like the Gates Foundation, are nervous of some of the things that citizens do and say." "If we don't address those issues around citizen activism, developing and protecting peoples' voices, then it will be very, very difficult to do anything other than leave the WHO as something that sits in some sort of space in Geneva about which ordinary people have no understanding and no interest," he concluded.
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