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Spain and Global Health System Governance: What Are We Talking about When We Talk about Influence?

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Photo: Paul Kagame / Flickr - Global Fund Pledging Session. New York, 21 September 2022.

If Spain wants to get more involved in global health, it needs to better understand the factors that influence the main bodies of the system, such as COVAX and The Global Fund.


The work of those of us in advocacy is to influence policy processes. At ISGlobal, we do this based on science and the scientific evidence produced by our researchers. On this basis, we propose concrete actions to policy makers to move towards health equity for all. The key is to identify who to address and what to propose to achieve the desired goal. In short, this is what we mean when we talk about influencing policy.

Over the past few months, ISGlobal’s Policy and Global Development department has been working with the Elcano Royal Institute to produce the report Development Aid and Influence in the Global Health System (Ayuda al desarrollo e influencia en el sistema de salud global). The report describes all the work needed to identify who to ask for what, based on a specific case study: how Spain influences two multilateral global health initiatives, COVAX and the Global Fund.

Increasing Spain’s influence on global health governance

The report's conclusions lead to a proposal for concrete actions and approaches to increase Spain's influence in global health governance after COVID-19. The report is not only timely, as the foundations of global health governance are currently being reviewed and redefined, but it also responds to Spain's desire to become a major international actor in the global health arena. This is evidenced by its commitment to contribute to the global response to the pandemic.

The study focuses on two multilateral initiatives in recognition of the importance of this type of partnership and the impact of their interventions over the last few decades. To this end, a twofold analysis is carried out: first, a description of their governance mechanisms and decision-making system; second, the elements that can influence these mechanisms. Next, key actors were identified and questions were posed to them (how has Spain exercised its influence in these spaces and what possibilities exist to increase it).

The result of this process is a series of recommendations on how to strengthen Spain's role in global health governance at a critical time. Generally speaking, influence in these areas is exercised by combining the weight of financial contributions with other elements such as proactivity, the ability to form alliances and the added value of its technical capacities.

Three key areas

In the case of Spain, there is considerable scope for increasing its influence in three key areas:

  1. Invest in building alliances Spain's presence on the boards of these organisations is shared with other donor countries and, in the case of the Global Fund, with the European Union, so this is a first level to mobilise this capacity. But this capacity can also be expanded by seeking like-minded allies on the boards, including partners from the Global South.
  2. Extend the current emphasis on Latin America’s importance to other thematic and geographical priorities of these initiatives, where Spain's capacity to influence can be increased.
  3. Strengthen the presence of its experts in implementation areas, where this technical advantage is underused.


All of this will increase Spain's proactivity in these areas and contribute to an influence that has recently benefited from high-level political representation and the active involvement of the Presidency in these issues. 

In the video below, you can see a more complete summary of this report on development aid and influence in the global health system (Ayuda al desarrollo e influencia en el sistema de salud global). It gives us the opportunity to share with you all some of the key elements of our advocacy work.