Revamping Global Health Architecture: Reforms by "Reports" [WHA79 PRIMER]

Readers,

If you are waiting with bated breath on the efforts to reform the global health architecture (likely not), there is perhaps no point getting too worked up about it. At least, not yet.

As things stand now, Geneva will witness a bunch of reports before a picture of what an altered landscape in global health emerges. This is undoubtedly a complex endeavour, also underpinned with many political and financial considerations.

In our edition today, a second of the two part primers this week, we present what's coming up on the reforms discussion at the World Health Assembly next week. (My young colleague from Sri Lanka, Kavishalinie Kanagasabai, a student at the University of Geneva, has helped us put this to together.)

We also present a mapping of the parallel reforms discussions that have occurred over the last few months. Pia Mehdwan brings all these strands into a single analysis. Mehdwan is a part of our annual fellowship program this year. Also, Julia Dötzer has worked on the illustrations that can be downloaded below.

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I. GHF WHA79 PRIMER

Revamping Global Health Architecture: Reforms by "Reports"

By Priti Patnaik & Kavishalinie Kanagasabai

Julia Dötzer designed the assets in this edition.

The response to the upending of global health, as a result of the dramatic and sudden cuts in official development assistance, has been slow, guarded and contentious. This should not be surprising given that a structure that has been built by layers upon layers of varied political and financial impulses, will need careful consideration of what comes next.

Experts and watchers fear that the future may be too tethered to the underlying structural, donor-driven dynamics of the past. Some have called for a decisive intervention from the middle powers, others want a smaller group of actors to nimbly decide on behalf of the rest. Multilateralism is useful but messy, so therefore there are both opportunities and threats in this twilight zone in global health governance.

Countries have, with some effort, come up with a draft proposal on how WHO can host such a discussion. This will be taken up next week at the World Health Assembly. We are told, that the last word on this has not been said yet. So, we will be watching the debate next week in Geneva when this comes up for consideration during the proceedings of the Assembly.

Key takeaways:

Challenges in health are increasing in the backdrop of contracting finances. There are competing priorities and ODA is declining.
There is a push for increased national ownership and capacities coupled with the need for strengthening regional health entities.
The current ecosystem is marked by duplicated functions and overlapping roles, competition, with inefficiencies and inadequate coordination and collective action.
WHO has suggested hosting a joint process that seeks to inclusive, time limited, efficient and transparent.
Though WHO plays a key role in guiding and coordinating global health, power centers lie elsewhere, including in other implementing and financing institutions, and private actors with deep pockets.
Just as WHO means different things for different countries, the role of allied actors such as Gavi - The Vaccine Alliance, for example, also has different meanings for different countries. Some are more dependent on such actors, than others. In short, there are nuances in how countries view the reforms discussion.
Activists say that without the aspirations of communities, reflected in these discussions, whatever comes next will be far from what is needed on the ground. (See statement from the CSO quarter below.)