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October 13, 2015

Responding To: WHO Director-General Continues Georgetown's Conversation on Global Governance

A Right to Functioning Healthcare Systems

Faith Boateng

WHO’s response to the Ebola crisis was swift and commendable though late in time due to delayed reporting. The development of an Ebola vaccine and its clinical trials gives the three African countries plagued by the virus and indeed the world at large confidence that never again will Ebola take as many lives, and it also signals that WHO’s preparedness against future crises is in order.

However, global health governance continues to suffer from failures to: prevent health problems from becoming global dangers, implement important treaties on global health, develop stronger health systems in developing countries and stimulate sufficient progress on social determinants of health. Many of these failures stem from broken health systems in countries like Guinea, Liberia and Sierra Leone—not just from inadequacies of international organizations.

Many African countries have broken health systems. Ghana, where I come from, has not experienced civil war, yet its health system is just as bad as some African nations which have experienced conflict. Lack of health facilities, crowded maternal wards with pregnant women and newly born babies lying helplessly on the floors, doctors and nurses on constant strikes on grounds of poor working conditions, frequent power cuts, and the payment of money before one receives health care (the “cash and carry” system), are some of the problems that plague these vulnerable African countries.

Governments have a responsibility for their people’s health which can only be fulfilled by the provision of adequate health and social measures. I, however, do not agree that citizens alone must hold governments up to their task. Despite efforts by citizens and civil society groups, governments have not done much about the situation and elections are often rigged to retain power, leaving the poor citizenry at the mercy of these broken systems.

It takes a much higher, more powerful and authoritative body to keep governments on their toes. In matters where fundamental human rights, respect for human dignity and social justice are being trampled upon, someone with a “say” must intervene.

The WTO has so far done well to ensure compliance with its TRIPS by imposing sanctions on non-compliant members. The ILO, FAO and UNESCO all have measures to ensure compliance with their laws within a specified time.

WHO admittedly is constrained in its enforcement powers but it is time for a reform. WHO must be able to act to give meaning to its establishment and ensure that there is compliance with its regulations and its constitution is upheld.

Monitoring committees must be established within WHO to ensure that proper health systems are put in place by members to ensure the highest attainable form of physical and mental health. WHO must be empowered to enforce its laws and to ensure compliance.

A body cannot set rules and standards and relegate its power of enforcement to another, especially when those entities are less powerful than the mandating body.

Teeth with which to bite is what the WHO needs for successful global health governance.   
Faith S. Boateng is a Global Health Law & Int’l Institutions LLM Candidate ’16 at Georgetown University Law Center

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