Last Friday, Stanford’s Policy Review published a feature written by global health luminaries Mark Dybul, Peter Piot, and Julio Frenk entitled Reshaping Global Health. The article reads as a call to action, urging the global health community to “give up a lot of turf” and assemble a Bretton Woods-style conversation to reshape the Global Health architecture.
The opening ten years of the 21st century arguably were the decade of global health. Resources increased significantly and many millions of lives were saved and improved….The resources currently available could have significantly greater impact with a more rational global health strategy and institutional structure focused on stewardship of available resources to achieve public goods—what is commonly called global health architecture.
The article clearly and succinctly outlines the key challenges facing the global health system today and proposes some key steps to fix them. I particularly enjoyed the emphasis on reclaiming the meaning of terms that have been over-used and therefore have lost their intention (think: accountability, transparency, and sustainability–do we really remember what those terms mean in a global health context anymore?).
They go on to highlight the overwhelming complexity of the architecture for funding:
As an example, within the UN system alone, and in spite of the existence of UNAIDS, eleven organizations are engaged in HIV/AIDS; the Global Fund provides 24 percent of external funding and the U.S. government 45 percent. Other bilateral institutions are in the game, as are large contributors like the Bill and Melinda Gates Foundation. Multiply that across all areas of health and one has a sense of the enormity of the challenge of coherent governance to support integrated health services.
A key element of the article is to highlight that the institutions which have been created to deliver global health funding in the last decades were built for specific diseases (Global Fund, PEPFAR, PMI). They argue that these institutions are now undermining the delivery of effective aid by making it impossible to integrate initiatives that look at the whole health of persons and systems. This explains why to solve the problem, these very same institutions will need to give up “turf.”
The article also provides some interesting perspectives on the central role of the WHO:
A symptom of what is wrong with the current institutional architecture of global health is the paradox that, at a time of financial expansion around disease-specific programs, there is severe underfunding of the knowledge-related global public goods that are essential for improving health outcomes.
The article ends with a call to action:
As delegates convened at a hotel in Bretton Woods, New Hampshire, in 1944, it was clear that the existing global finance governance mechanisms were too divided and chaotic to cope with the world economic situation. As we emerge from a decade of rapid expansion in global health that began with the conceptual foundations for a new era in development and approach the post-MDG era, now is the time for a Bretton Woods-styled consensus to create a new architecture for the governance of global health.
Thank you to Dybul, Piot, and Frenk for opening the dialogue with this thought-provoking piece. I would dub it essential reading for policymakers, implementers, and anyone concerned with the future of global health development.