Global Health Governance: The Indispensable Role of National Health Systems
Margaret Chan | October 15, 2015
October 13, 2015
Responding To: WHO Director-General Continues Georgetown's Conversation on Global Governance
Better Coordinated Coordination Mechanisms
Tobias Vestner
At her lecture on challenges to global health, Margaret Chan shared her experience with global crises: Confusion reigns, systems do not work, and coordination is difficult. Moreover, duplication and fragmentation of efforts undermine efficiency and efficacy. WHO is currently working to remedy its own insufficiencies, which were revealed during the Ebola crisis. But reforming WHO is not enough. We need to better coordinate the entire network of international institutions involved in disaster prevention and relief.
International institutions, such as WHO, are notably created to solve coordination problems. They are focal points for international cooperation, provide information and expertise, and allow burden sharing. WHO is the central node of the global health architecture. But as Margaret Chan has pointed out, today’s challenges are interrelated. Health is notably related to economic development, the environment, migration, human rights, and security. Accordingly, WHO not only works with partners that are specialized in health issues but also with heterogeneous actors with a wide diversity of expertise. Moreover, the increase of international institutions and non-governmental initiatives makes the coordination of activities even more difficult, as there are overlapping competences and competing priorities of the many actors.
International institutions, such as WHO, are notably created to solve coordination problems. They are focal points for international cooperation, provide information and expertise, and allow burden sharing. WHO is the central node of the global health architecture. But as Margaret Chan has pointed out, today’s challenges are interrelated. Health is notably related to economic development, the environment, migration, human rights, and security. Accordingly, WHO not only works with partners that are specialized in health issues but also with heterogeneous actors with a wide diversity of expertise. Moreover, the increase of international institutions and non-governmental initiatives makes the coordination of activities even more difficult, as there are overlapping competences and competing priorities of the many actors.
Consequently, we need to rethink the existing coordination mechanisms. The whole-of-government approach enhances states’ ability to navigate in an increasingly complex and interdependent world. Many of its concepts can be applied to the global governance structure, namely:
- The international institutions’ responsibilities should be clarified. This leads to a better understanding of where competences start, where they stop, and at which point competences of others come in. If WHO is not only a technical agency but also a first responder, for which tasks, and under which conditions is it in the lead?
- The leadership of international organizations should meet regularly in order to share information and discuss policy options. This would be the equivalent of interagency meetings at the government level. These meetings should be neither hierarchical nor focused on decision making but rather be for informative purposes only. Moreover, it would help to prevent faits accomplis on the field.
- A committee that serves as a focal point for cooperation among institutions should be established. It could facilitate information exchange, monitor cooperation activities, and propose advice for coordination. As such, it would act as an honest broker between organizations - comparable to the U.S. National Security Council but with the exception that there is no final authority such as the President.
- Staff of international institutions should be incentivized to better coordinate their work with other organizations. Having staff members, especially those at the management level, move from one organization to another fosters interdisciplinary problem-solving. It also generates reliable networks. Moreover, staff are likely to be more cooperative with representatives of other organizations if they might become colleagues at a later stage of their career.
The focus of these actions is to enhance formal and informal coordination among international institutions. During crises, the proposed regular meetings among top officials could be similar to those in the White House Situation Room. Centralized decision making, however, is neither practical nor desirable. Moreover, the Ebola crisis has shown that high politics do not necessarily help managing crises. Better coordination mechanisms should start at the technical level. The reform of WHO, the implementation of the Sustainable Development Goals, and the reform of the UN system are potential entry points. Lessons learned from the "cluster approach" may serve as a starting point.
Tobias Vestner is a MSFS student and a Global Futures Fellow.
- The international institutions’ responsibilities should be clarified. This leads to a better understanding of where competences start, where they stop, and at which point competences of others come in. If WHO is not only a technical agency but also a first responder, for which tasks, and under which conditions is it in the lead?
- The leadership of international organizations should meet regularly in order to share information and discuss policy options. This would be the equivalent of interagency meetings at the government level. These meetings should be neither hierarchical nor focused on decision making but rather be for informative purposes only. Moreover, it would help to prevent faits accomplis on the field.
- A committee that serves as a focal point for cooperation among institutions should be established. It could facilitate information exchange, monitor cooperation activities, and propose advice for coordination. As such, it would act as an honest broker between organizations - comparable to the U.S. National Security Council but with the exception that there is no final authority such as the President.
- Staff of international institutions should be incentivized to better coordinate their work with other organizations. Having staff members, especially those at the management level, move from one organization to another fosters interdisciplinary problem-solving. It also generates reliable networks. Moreover, staff are likely to be more cooperative with representatives of other organizations if they might become colleagues at a later stage of their career.
The focus of these actions is to enhance formal and informal coordination among international institutions. During crises, the proposed regular meetings among top officials could be similar to those in the White House Situation Room. Centralized decision making, however, is neither practical nor desirable. Moreover, the Ebola crisis has shown that high politics do not necessarily help managing crises. Better coordination mechanisms should start at the technical level. The reform of WHO, the implementation of the Sustainable Development Goals, and the reform of the UN system are potential entry points. Lessons learned from the "cluster approach" may serve as a starting point.
Tobias Vestner is a MSFS student and a Global Futures Fellow.
Other Responses
Investing in Global Health
Emily Mendenhall | October 14, 2015
The Indispensable Role of Law
Oscar Cabrera and Susan C. Kim | October 14, 2015
Data Collection: A Grassroots Approach
Alex Rohlwing | October 13, 2015
Lessons Learned from the Ebola Crisis
Anna Tordjmann | October 13, 2015
Duties to Care for the Other and for the Unknown
Emmanuel Foro | October 13, 2015
A Right to Functioning Healthcare Systems
Faith Boateng | October 13, 2015
Global Health as a Common Good
François Pazisnewende Kaboré | October 13, 2015
Cross-sector Collaboration
Patrice Ndayisenga | October 13, 2015