Workshop on Democratising Global Health Governance, Geneva, 14-15 May, 2010.
Representatives of a range of civil society organizations working in health met over two days in Geneva, 14-15 May 2010, to review current structures of global health governance; consider possible directions for reform and adopt strategies for driving such reform.
The discussion of governance issues was shaped by concerns for deepening inequalities and by an awareness of the harm and future dangers of the food, financial and climate crises.
The meeting recognized GHG as a sub-domain of global governance and strongly shaped by economic policy priorities, rather than an autonomous domain of governance, responding primarily to health needs and considerations. The meeting reviewed the contemporary global governance of: human resources for health, trade and health, social determinants, primary health care and health care financing. In each case the presentations and plenary discussion sought to:
- delineate the main global structures and dynamics driving current policies and trends;
- explore recent case studies of episodes of policy making to analyse more closely how civil society and how low and middle income countries had engaged in policy and implementation;
- consider how the processes of GHG could be rendered more democratic; more attuned to the WHO definition of health; more aligned with universal human rights; and more expressive of basic values of human solidarity.
The meeting concluded that the way in which the contemporary regime of GHG operates contributes to the continued high burden of avoidable ill-health globally and this regime should be challenged and reformed. The continued net flow of health professionals from the South to the North represents a massive transfer of resources away from L&MICs which far outweighs the value of international aid. Despite the recommendations of the WHO Commission on Social Determinants the health policy directions of the international financial institutions and various global health initiatives continue to ignore the social determinants and the role of comprehensive primary health care in mobilizing communities around these issues. Key features of the WTO trade agreements and the bilateral trade agreements are having very damaging impacts on population health and health care; especially the agreements on agriculture, services and intellectual property. Prevailing policies in relation to international aid are directed at preventing urgently needed intellectual property reform and preventing attention to necessary reforms to the economic regime.
The meeting reviewed and reflected on a number of episodes in which the pressures of neoliberal economic policies on health had been successfully resisted and noted the role of local action by community based groups, international solidarity and linking direct political action with technical analysis.
The meeting identified a range of strategies through which a movement for global governance reform, including GHG, might be built. Participants agreed that working with ministries (and ministers) of health and parliamentarians should be a key strategy. This would include collaboration among MOHs; alliances between MOHs and civil society and strengthened intersectoral collaboration, especially with Trade and Finance, at the national and international levels. The meeting also recognized that as well as capacity building for government officials there is a need to build the capacity of progressive civil society networks to engage with the dynamics of global health governance including sustained educational opportunities for young health activists. It was recognized that any movement for the reform of GHG must work in close collaboration with wider movements pressing for the reform of global economic governance.
The meeting resolved to launch a GHG reform initiative in accordance with the broad analysis and directions emerging from the two days of discussions. The meeting commissioned an interim steering group to:
- prepare a detailed report from this meeting for wider consideration;
- prepare a shorter ‘manifesto’ summarizing the issues and calling for wider participation in the proposed initiative;
- publicise the proposed GHG reform initiative and invite a wider range of organizations and countries to join (or to associate in some appropriate way);
- recruit or coopt additional members to this interim steering group, including in particular, appropriate MOH personnel;
- develop a suite of proposals for actions which would contribute to GHG reform and which might be implemented in different places by different organizations as part of an inclusive campaign;
- investigate possible host organisations or funding sources to support the coordination and continued prosecution of such a campaign; and
- report back on the progress of the initiative to this widening constituency.
The initial members of the Interim Steering Group include: People’s Health Movement, South Centre, Health Action International, Third World Network, Medicus Mundi International, Cordaid, Geneva Forum for Health, Medico International.