To Go Far in Global Health, Why Can’t We Go Together?

If they seek the same ambitious goals why do such actors not work together more closely? Where are the synergies in the global health arena?/q>

Trying to comprehend the world of global health isn’t simple. It brings together a variety of actors from across the globe. Among them are international global organisations (IGOs) such as the WHO, public private partnerships (PPPs), partner governments, academics, research centres, health specialists, civil society organisations and, of course the United Nations (UN).

They share similar targets, namely achieving then the Millennium and now Sustainable Development Goals (SDGs), the new global agenda. Whilst advocating for their individual causes, they all conceive the need for strengthening health systems in the pursuit of universal health coverage. Yet here lies the great paradox, if they seek the same ambitious goals why do such actors not work together more closely? Where are the synergies in the global health arena? And why does the global health community continue to shy away from establishing deeper and more profound collaborations?

SDG discussion in Cairo, Egypt

Yet the formation of synergies in global health is no new phenomena. In 2007, former World Health Organization (WHO) Director General Margaret Chan stated; “Given the growing complexity of these health and security challenges and the response required, these issues concern not only governments, but also international organisations, civil society and the business community. Recognising this, the WHO is making the world more secure by working in close collaboration with all concerned”. And so, the WHO Maximising Synergies initiative was launched in an attempt to boost “collaboration”. However, since its emergence in 2008, it appears to have made little impact.

Even today, the continued shortfall in synergies in global health impedes forward thinking and stunts country development. This is clearly reflected by organisation’s country eligibility criteria. Whereas GAVI determines country eligibility based on Gross National Income per capita (GNI), other actors such as the Global Fund implement GNI, combined with the official disease burden classification. As a result, countries such as Bolivia meet certain funding criteria, but not others. However through synergising, actors and organisations gain opportunities to streamline such strategies, offering what resembles greater continuity of care. Where similar to primary care provision, one can find the immunisation specialist (GAVI) just two doors down from the gynaecologist (PMNCH).

Even today, the continued shortfall in synergies in global health impedes forward thinking and stunts country development

So, if synergising offers a wealth of possibilities, why do actors continue to shy away from it? Of course, synergy formation requires a willingness to engage. It could be that certain organisations are simply reluctant to take this next step. Included here are philanthropic actors, some of whom possess considerable influence over policy and global governance. Synergising would arguably reduce individuals’ scope for influencing policy. Furthermore, the emergence of actors in the field of global health has occurred principally on an ad hoc basis in response to epidemics, global health security and heightened public consciousness.

Manhiça District Hospital (Mozambique)

Included here is the ‘AIDS awakening’ of the 90s, and the birth of actors such as the Global Fund. As a result, actors have been “defined as much by political and economic power, as by health needs and priorities”, stated Kelley Lee, discussing the functions of Global Health Governance, 2016. Thus the prospect of creating stable, overarching synergy-based frameworks, contrasts with the current ad hoc crisis management models of independent actor emergence.

Aside from political and individual will, the current ‘market-style’ approach to global health provision presents as equally problematic

Aside from political and individual will, the current ‘market-style’ approach to global health provision presents as equally problematic. Are current methods simply functioning as business models as opposed to development mechanisms? Equipping developing nations with the tools to begin their own vaccine and medicine production ultimately stunts the global reach of Big Pharma. This has more recently been emphasised by Donald Trump’s protectionist Pharma-backed approach to policies.

This trade-off between capital and universal health provision, leads us to a much greater paradox; as expressed by the late Dr. Joep Lange: “If we can get cold Coca-Cola and beer to every remote corner of Africa, it should not be impossible to do the same with drugs”.

Pilot in Burkina Faso for MenAfriVac immunization campaign / WHO

Ultimately, universal health provision is based on the understanding that “health is a human right, not a privilege”, posited WHO Director General, Dr Tedros Adhanom Ghebreyesus, whereas inadequate access and provision posit health as a luxury good. In this instance, boosting synergies between the big actors in global health and civil society organisations (CSOs), surely present a solution.

Boosting synergies between the big actors in global health and civil society organisations (CSOs) surely present a solution

Civil societies offer the scope to engage at the individual and international level. CSOs wield the potential to connect grassroots with the top echelons of global governance, whilst delivering on the ground primary care, free from the constraints of policy objectives and market economics. But is the current lack of engagement founded on the notion that “West knows best”, whereby forging partnerships with CSOs in developing countries inevitably leads to a power vacuum? As connections and synergies strengthen, CSO knowledge, autonomy and empowerment increase, in turn destabilising the value and relevance of the overarching actor.

Yet, in an époque tinted by the rise of the right and political separatism, it seems that unity and shared commonalities have fallen by the wayside. While global health indicators still fall short of the SDG targets, and the threat of another pandemic lingers, surely it is in our best interest for the kingpins of global health to buddy up, work together and seek out synergies, from the grassroots of CSOs, to the upper echelons of global health governance. Because after all, “the whole is greater than the sum of its parts” —Aristotle.