DPH 830 Module 7 International Organizations and Governance Example

Many Players, No Referee: International Organizations and the Governance of Global Health

Student Name

Doctor of Public Health Program, Aspen University

DPH 830: Global Health

Instructor Name

Month Day, Year

Many Players, No Referee: International Organizations and the Governance of Global Health

Global health once had a clear center: the World Health Organization, created in 1948 to direct and coordinate international health work. Today it shares the field with development banks, United Nations agencies, global funds, private foundations and nongovernmental organizations. This paper examines the roles of these organizations, the functions the global health system must perform and the governance challenges that arise when no single body is in charge.

An Expanding Cast

Szlezák et al. (2010) describe a global health system in transition, as the number and diversity of actors grew rapidly in the 2000s. New funders and partnerships brought money and energy but also fragmentation, duplication and questions about who sets priorities and who is accountable.

Major Organizations

The table summarizes major organizations and how they work.

Core Functions

The global health system performs functions that no single country can: producing global public goods such as research and standards, managing cross-border threats such as pandemics, mobilizing solidarity for countries that cannot finance basic care and providing stewardship to set priorities and coordinate action. Different organizations perform different functions, and gaps appear where none takes responsibility.

Three Governance Challenges

Frenk and Moon (2013) identify three challenges. The sovereignty challenge arises because health is determined within nations but threats cross borders, and states resist outside direction. The sectoral challenge arises because health is shaped by trade, agriculture and other sectors outside health ministries. The accountability challenge arises because many powerful actors are not answerable to those affected by their decisions.

Global Health Law

International law provides some binding tools. The International Health Regulations require countries to build surveillance and response capacities and to report potential emergencies, and the Framework Convention on Tobacco Control commits parties to evidence-based tobacco measures. Gostin and Sridhar (2014) argue that the World Health Organization has underused its power to create binding law, relying instead on nonbinding guidance.

Lessons From Ebola

The 2014 Ebola epidemic exposed weaknesses in global governance. An independent panel found that the World Health Organization was slow to declare an emergency, that countries lacked required capacities and that coordination among agencies was poor. Its recommendations included stronger country capacities, a dedicated emergency center and independent accountability (Moon et al., 2015).

Earmarked Funding

Much of the World Health Organization's budget comes from voluntary contributions earmarked by donors for specific programs. Earmarking lets donors pursue their priorities but limits the organization's ability to set its own agenda and fund core functions such as standard setting and emergency preparedness. Member states have agreed in recent years to raise assessed contributions gradually, a step toward greater independence.

Vertical and Horizontal Approaches

Disease-specific funds have achieved dramatic results for HIV, tuberculosis, malaria and vaccines, but critics argue they can draw staff and attention from general health services. Increasingly, funders support health system strengthening alongside disease programs, recognizing that each depends on the other. Shared supply chains and health worker training benefit both kinds of programs.

Country Ownership

Effective partnership requires that national governments lead, set priorities and coordinate donors around one plan, one budget and one monitoring framework. Where many partners run parallel programs, ministries spend time managing donors rather than delivering services. Donors who align with national plans and report through national systems reduce this burden.

Working With Multiple Partners

A national program director managing support from several organizations should map each partner's funding, priorities and reporting requirements, convene partners around the national strategy, negotiate aligned indicators and push for pooled or flexible funding. Transparency about who funds what builds trust and reduces duplication.

Civil Society and Communities

Civil society organizations, including patient groups and community organizations, have shaped global health through advocacy, service delivery and accountability. The HIV movement's influence on treatment access shows how affected communities can change global priorities. Their seats on the boards of global funds give affected communities a formal voice.

Reform Directions

Proposed reforms include increasing flexible funding for the World Health Organization, strengthening binding rules for pandemic preparedness, creating independent accountability mechanisms and giving low- and middle-income countries a larger voice in governing bodies. Progress depends on political will among member states.

Public-Private Partnerships

Many global health initiatives combine public agencies, private companies and foundations. Gavi and the Global Fund include private and civil society representatives on their boards. Such partnerships can mobilize resources and expertise but raise questions about conflicts of interest and whose priorities prevail when commercial and public interests diverge.

The Role of Foundations

Large private foundations have become among the biggest funders of global health, supporting research, vaccines and disease programs. Their flexibility allows rapid action and risk taking, but their priorities are set by boards rather than by affected populations, and their influence over agendas has drawn scrutiny from those concerned about accountability.

Regional Organizations

Regional bodies play growing roles. The Pan American Health Organization serves as WHO's regional office for the Americas while retaining its own identity, and Africa CDC coordinates surveillance and response across African countries. Regional organizations can bring decisions closer to the countries they serve.

Measuring Performance

Organizations should be judged by results for health, not only by funds disbursed or activities completed. Independent evaluations, transparent reporting and feedback from recipient countries help hold organizations to account. Several global funds now publish detailed results by country and grant, a practice others could follow.

Pandemic Preparedness

The COVID-19 pandemic renewed debate about global health governance, including negotiations on a pandemic agreement and amendments to the International Health Regulations. Issues include equitable access to vaccines and treatments, sharing of pathogen data and financing for preparedness in lower-income countries.

Working Across Sectors

Many determinants of health lie outside the reach of health agencies. Trade agreements affect access to medicines, agricultural policy shapes diets and finance ministries set tobacco and alcohol taxes. Global health governance increasingly requires health organizations to engage these sectors, including the World Trade Organization and development banks.

Conclusion

Global health governance involves many organizations with different mandates, funding and tools, and no single authority. Challenges of sovereignty, sectors and accountability, exposed sharply during Ebola, call for stronger law, flexible funding, country ownership and accountability to affected populations. Public health leaders working internationally must navigate this complex system with clarity about each partner's role.

References

Frenk, J., & Moon, S. (2013). Governance challenges in global health. New England Journal of Medicine, 368(10), 936-942. https://doi.org/10.1056/NEJMra1109339

Gostin, L. O., & Sridhar, D. (2014). Global health and the law. New England Journal of Medicine, 370(18), 1732-1740. https://doi.org/10.1056/NEJMra1314094

Moon, S., Sridhar, D., Pate, M. A., Jha, A. K., Clinton, C., Delaunay, S., Edwin, V., Fallah, M., Fidler, D. P., Garrett, L., Goosby, E., Gostin, L. O., Heymann, D. L., Lee, K., Leung, G. M., Morrison, J. S., Saavedra, J., Tanner, M., Leigh, J. A., ... Piot, P. (2015). Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. The Lancet, 386(10009), 2204-2221. https://doi.org/10.1016/S0140-6736(15)00946-0

Szlezák, N. A., Bloom, B. R., Jamison, D. T., Keusch, G. T., Michaud, C. M., Moon, S., & Clark, W. C. (2010). The global health system: Actors, norms, and expectations in transition. PLoS Medicine, 7(1), Article e1000183. https://doi.org/10.1371/journal.pmed.1000183