Joint Action and Learning Initiative
Aid Effectiveness, global health faces challenges of weak leadership, poor coordination, underfund- ed priorities, and a lack of transparency, account- ability, and enforcement.
Innovative global governance and enhanced fund- ing would empower WHO to exercise effective leadership in the health sector and persuasive ad- vocacy on agriculture, finance, and trade. More- over, state policies (e.g., agricultural subsidies, intellectual property, and foreign affairs) can pow- erfully affect health in resource-poor countries. States, therefore, should adopt a “health-in-all- policies” approach where all ministries address the health impacts of their policies and programs. Effective governance must include active citizen participation to ensure transparency, collaboration, and accountability while maximizing creativity and resource mobilization by states, international or- ganizations, businesses, and civil society.
The global health architecture must hold stake- holders accountable, with clear standards for suc- cess, monitoring progress, and enforcement—all of which have been lacking. Lack of sufficiently precise obligations and compliance mechanisms under the right to health hinders accountability, though promising approaches exist. Human rights bodies and UN Special Rapporteurs are adding clarity required for meaningful accountability, as are constitutional courts decisions in Argentina, Colombia, India, and South Africa.
Innovations in human rights law and practice hold potential for greater accountability. Regional right to health special rapporteurs could be established, enabling more effective national engagement. An empowered human rights sector could learn from international regimes with more vigorous adju- dication and enforcement mechanisms, such as trade. Actions to ensure that social movements and voters are well informed about their coun- tries’ commitments could strengthen political accountability.
The global South, where most of the world’s
least healthy people reside, should lead in shap- ing global governance for health policies, where community priorities drive global action. New governance requires the full participation of, and support for, marginalized populations.
Why would states agree to greater accountability when so many countries fail to adhere to exist- ing commitments? We do not underestimate the gravity of the challenge, yet JALI offers possibili- ties of success. Social mobilization could ignite new possibilities, as the AIDS movement has done, unleashing the collective power of health advocates and empowered communities.
The framework of mutual responsibilities that emerges from JALI should prove attractive to both Southern and Northern governments, cre- ating incentives to develop a far-reaching global health agreement. Mutual responsibilities come with mutual benefits. Southern countries will benefit from increased respect for their strate- gies, greater and more predictable funding from more coordinated and accountable development partners, reform of policies that harm health, such as in trade and agriculture, and most importantly, better health for their populations. Countries in the North will benefit from increased confidence that development assistance is spent effectively and the prospect of reduced financing needs over time as host countries increase their own health spending and build sustainable health systems. All will benefit from lessons on shared health challenges, from the economic and educational gains that will come with improved global health, and from increased protection for their popula- tions from global public health threats – and from mutual goodwill derived from participating in a historic venture to make unprecedented progress towards global health equity.
This is also a moment of rare opportunity. The post-MDG global health framework is yet to be developed. Demand for accountability is growing. National and global health funding is increasing,
ILSA Quarterly » volume 20 » issue 1 » October 2011
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