Global health initiatives are organizations that fund other organizations that implement programs and research on global diseases. These initiatives are one of the benefits of globalization. GHIs provide additional resources to health efforts on a global scale. GHIs source for funds and disburse them to organizations all around the world that deal with major global diseases like malaria, tuberculosis and HIV/AIDS. These initiatives have majorly contributed in saving lives of millions of children and adults and help in improving health of affected citizens worldwide. Examples of global health initiatives include Global Alliance for Vaccines and Immunization, Global Fund to fight AIDS, Tuberculosis and Malaria, US President’s Emergency Plan for AIDS Relief, Roll back malaria and Stop TB. All global health initiatives aim to address health-related Millennium development goals.
Defining global health governance requires one to split the term into two, namely global health and governance. Global health is the collaborative trans-national promotion of health (Beaglehole and Bonita, 2010). This is an area of study whereby priority is placed on health issues that surpass national borders and governments and focuses on improving health for everyone worldwide. It promotes health issues and the solutions to overcome diseases. It involves inter-disciplinary collaboration as it involves both health and non-health disciplines. In addition, global health strengthens systems that are mandated with delivering health services. Governance is the defined set of actions adopted by a society to exercise power in response to challenges. Global health governance encompasses a number of regulations that deal with international problems in health.
This essay discusses the impact of global health governance on global health initiatives. The paper begins with a section on elements of global health governance. This is followed by a section on the impact of global governance on GHIs.
Elements of Global Health Governance
There are three elements of global health governance (Dodgson et al, 2002). The first being deterritorialization which involves the promotion of health across countries and geographical borders. Countries should not be left out of health promotion because of their political stands or geographical positions. The second element is the adoption of determinants of health from a multi-sectoral perspective. Several sectors have a broad impact on human health, for instance natural environments, trade and agriculture. These non-health sectors should be incorporated in the espousal of determinants of health. The third element entails the involvement of formal and informal actors. Various parties act as stakeholders to global health governance. At the centre are the World Bank and the World Health organization (WHO) who provides finances and health expertise, respectively. Other stakeholders are made up of organizations from civil and private sectors, for instance United Nations Development Programme (UNDP), United States Agency for International Development (USAID), and other Non Governmental Organizations (NGOs). Many scholars are of the same opinion that public and private actors are essential in administering global health (Aginam, 2007).
Global Health Initiatives (GHIs)
Global Health Initiatives are known to fund disease-specific interventions. The funds provided by GHIs are mostly used in research and implementation programs in low and middle income countries (LMICs). Global health funding has increased dramatically over the past decade. According to the World Bank (2007) global health funding has increased from US$ 2.5 billion to US$14 billion from 1990 to 2005. The initiatives pride themselves in having great influence in averting preventable deaths due to various diseases like tuberculosis, malaria and HIV/AIDs. GHIs also increase coverage of interventions with an aim to reach those individuals who are most in need. In addition, GHIs increase access of health goods and services by scaling up cost-effective interventions. There are currently approximately 100 GHIs in the world.
Global health governance permits different GHIs to form partnerships. An example of such a partnership is the Health 8. This alliance has eight members namely United Nations Population Fund (UNFPA), GAVI, Bill and Melinda Gates Foundation (BMGF), United Nations International Children’s Emergency Fund (UNICEF), Global Fund, United Nations Joint programme on Acquired Immune Deficiency Syndrome (UNAIDS) and WHO. Another partnership called International Health partnership (IPH) was launched in 2007. It comprises of several member countries and GHIs whose aim is to achieve the Millenium Developmental Goals (MDGs) that are health-related.
For a long time, governance on global health has been led by WHO, World Bank and other agencies for instance USAID and Department of International Development (DfID). A new group of initiatives, Global Health Initiatives, are striving for influence in global health.
The subsequent sections and paragraphs provide examples of Global health initiatives that have had a massive positive impact worldwide. Elements of global health governance that enable GHIs to implement their programmes are also discussed.
US President’s Emergency Plan for AIDS Relief (PEPFAR)
Global health governance permits global health initiatives to deal with international problems in health. HIV/AIDS is a serious viral global disease that mainly affects individuals in Africa and South Asia. The President’s Emergency Plan for AIDS Relief (PEPFAR) is an initiative that was founded by former U.S. President George W. Bush. The initiative was established in 2003 with an aim to fight the HIV/AIDS scourge. Majority of the deaths in sub-Saharan Africa are HIV/AIDS related deaths. In 2006, the initiative provided antiretroviral therapy to approximately 800,000 to persons with the disease (Institute of Medicine, 2007). In addition, 4.5 million persons were provided with care and support.
One of the elements of global health governance that has been adopted by PEPFAR is deterritorylisation. Global health governance allows initiatives and organizations to work across borders to promote health initiatives. PEPFAR has implemented programs in 15 countries worldwide, with 12 of these countries in Africa.
The initiative supports prevention programs as well as implementation programs. Another characteristic of global health governance that has been embraced by PEPFAR is partnerships with health and non-health sectors. PEPFAR promotes public-private partnerships (PPP). The institution is works hand in hand with other actors namely the public and private sector. PEPFAR private sector partners include private businessmen, foundations among others. These partnerships are important funding sources as they contribute to monies that will be sued in prevention, treatment and care of people living with HIV/AIDS.
Recently, in August 2012, PAPFER partnered with three organizations to significantly reduce the cost of a tuberculosis rapid diagnostic test. The three partners who signed an agreement with PEPFAR include Bill and Melinda Gates Foundation, UNITAID (that purchases drugs for HIV/AIDS) and USAID. Tuberculosis has been documented to be the leading cause of deaths among HIV/AIDS patients. Thus reduction of purchase of a tuberculosis diagnostic kit will greatly help in the diagnosis of the disease among people living with HIV/AIDS.
Global Fund to fight AIDS, Tuberculosis and Malaria
The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) is a global health initiative that raises funds to finance Governments. It was founded in 2002 but its birth was in the year 2000 at a global G8 summit in Japan. WHO and UN agencies realized the need to have a united body that funds programs that fight major global infectious diseases. The funds are used to promote research and implementation programs in three major global diseases namely HIV/AIDS, Tuberculosis and Malaria. The finances are used in programs that prevent, treat and reduce deaths caused by the three diseases. Through global health governance, GFATM is enabled to deal with three international health problems. To date, GFATM is the largest body that funds HIV/AIDS programs worldwide.
GFATM works in partnership with the private sector and governments. The private sector consists of private businessmen and foundations. Donor governments that provide funds to Global Fund include U.S.A., U.K., Germany, France, European Commission, Japan among other European countries. This partnership fosters global health governance and enables The Global Fund to operate in its maximum capacity.
The Global Fund grants money to Governments who then decide on how best to use the money to implement their country programmes. The GHI funds approximately 151 countries and over 1,000 programs worldwide.
Global Alliance for Vaccines and Immunization (GAVI)
The Global Alliance for Vaccines and Immunization is an initiative that aims to save lives of children by providing vaccine product and improving access to immunization. The organization was launched in 2000 with a goal of funding vaccines to be administered to children in developing countries.
GAVI is also a public-private health partnership. The alliance comprises of the Bill and Melinda Gates foundation, World Bank, developing countries, UNICEF, public health institutions, the vaccination industry among other bodies. Global health governance is characterized by institutional and political relations. This is particularly articulated by GAVI.
The Bill and Melinda Gates foundation was the first partner to give funds to GAVI in 1999. The power of GAVI is in its partnership with the private and public sectors. The initiative relies heavily on civil societies to ensure immunization services reach the poorest countries and individuals. The initiative also relies on UNICEF to procure and supply the vaccines. GAVI also partners with developing countries such that they contribute to their vaccine costs. Since its initiation in the year 2000, GAVI has managed to avert 5.5 million deaths. The vaccines that the alliance administers include vaccines against childhood meningitis, hepatitis B among others.
Roll back Malaria
Roll back malaria like all other GHIs comprises of a partnership. It is a global partnership whose aim is to combine efforts to reduce malaria morbidity and deaths globally. The initiative calls upon partners to mobilize resources and unify action against malaria. The partnership base comprises of about 500 partners who include academic institutions, developing countries, foundations, research institutions, malaria endemic countries among others. RBM was founded by the WHO, UNICEF, and World Bank in 1998. It aim was to reduce the malaria burden in half by the year 2010. Partnerships are an important characteristic of global health governance that has successfully been adopted by Roll back malaria. Global health governance presents the opportunity for GHIs to pool together resources and expertise in various health sectors. The main strength of the Roll back Malaria is in its diverse expertise from partners.
Approximately 90% of the world’s malaria burden is in sub-Saharan Africa. This is majorly the region that RBM concentrates its efforts. RBM’s main target group includes pregnant women and children under the age of five years. The initiative aims to increase the use of malaria interventions. These interventions include use of insecticide treated mosquito nets, prompt access to malaria treatment, and prevention of malaria in pregnancy.
Bill and Melinda Gates Foundation
The Bill and Melinda Gates’ Foundation (BMGF) was founded in the year 2000. The foundation funds research institutions and organizations whose focus is on malaria, HIV/AIDS, maternal health, and immunization. BMGF funds other global health initiatives for instance Roll back malaria, Global alliance for vaccines and immunizations and Global Fund. As much as they fund other GHIs, BMGF also work in partnership with them.
The foundation has prided itself in funding innovations in various health sectors. It has been in the forefront for development of new vaccines for infectious diseases like malaria. Through global health governance, BMGF funds institutions all over the world.
Conclusion
In Conclusion, global health governance includes several regulations that deal with international problems in health. Global health initiatives mobilize funds that are used to prevent and control diseases in low and middle income countries. Global health governance promotes health initiatives across national borders. This enables global health initiatives to carry out their activities in any country in the world. Global health governance is a concept that involves formal, informal and non-health actors. Many GHIs are funded by donors from both private and public sectors. The private sector can be composed of foundations and private businessmen while public sectors are governments. GHIs are characterized by partnerships and associations which is an element of global health governance. Different organizations come together to gather resources that will promote health initiatives worldwide.
Global health governance presents the opportunity for GHIs to pool together resources and expertise in various health sectors. This is presented by various GHIs like Roll back malaria whose partners have various skills and expertise that enrich their contribution to the initiative. All GHIs in the long run aim to address Millennium development goals.
References
Aginam, O., 2007. ‘Global governance’. In: S. Galea, ed. Macrosocial determinants of population health. New York: Springer, Chapter 7.
Dodgson, R., Lee, K. and Drager, N. (2002). Global Health Governance: A conceptual review. Geneva: World Health Organization and London School of Hygiene and Tropical Medicine.
Fidler, D. 2007. ‘Architecture amidst anarchy: global health’s quest for governance’. Global Health Governance, 1 (1), 1_17.
Institute of Medicine. 2007. PEPFAR Implementation: Progress and Promise. Washington, DC: National Academies Press.
Robert Beaglehole, R. and Bonita, R. 2010. What is Global health? Global Health Action, 3: 5142.
World Bank. 2007. Healthy Development: The World Bank Strategy for Health, Nutrition, and Population Results. Washington, DC: World Bank. Version: 22 February 2007.
