Recent Shifts in Global Governance: Implications for the Response to Non-communicable Diseases

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Abstract

Devi Sridhar and colleagues discuss how three major trends in global governance, the rise of emerging economies, the increase in multi-bi financing and institutional proliferation, have ramifications for whether NCDs will be included in the post-2015 Sustainable Development Goals agenda.

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Most cited references 11

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An assessment of interactions between global health initiatives and country health systems.

(2009)

Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money, and outcomes in global public health, then these opportunities should not be missed.

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WHO's budgetary allocations and burden of disease: a comparative analysis

David Stuckler, Lawrence King, Helen Robinson … (2008)

Summary Background Ministers of health, donor agencies, philanthropists, and international agencies will meet at Bamako, Mali, in November, 2008, to review global priorities for health research. These individuals and organisations previously set health priorities for WHO, either through its regular budget or extra-budgetary funds. We asked what insights can be gained as to their priorities from previous decisions within the context of WHO. Methods We compared the WHO biennial budgetary allocations with the burden of disease from 1994–95 to 2008–09. We obtained data from publicly available WHO sources and examined whether WHO allocations varied with the burden of disease (defined by death and disability-adjusted life years) by comparing two WHO regions—Western Pacific and Africa—that are at differing stages of epidemiological transition. We further assessed whether the allocations differed on the basis of the source of funds (assessed and voluntary contributions) and the mechanism for deciding how funds were spent. Findings We noted that WHO budget allocations were heavily skewed toward infectious diseases. In 2006–07, WHO allocated 87% of its total budget to infectious diseases, 12% to non-communicable diseases, and less than 1% to injuries and violence. We recorded a similar distribution of funding in Africa, where nearly three-quarters of mortality is from infectious disease, and in Western Pacific, where three-quarters of mortality is from non-communicable disease. In both regions, injuries received only 1% of total resources. The skew towards infectious diseases was substantially greater for the WHO extra-budget, which is allocated by donors and has risen greatly in recent years, than for the WHO regular budget, which is decided on by member states through democratic mechanisms and has been held at zero nominal growth. Interpretation Decision makers at Bamako should consider the implications of the present misalignment of global health priorities and disease burden for health research worldwide. Funds allocated by external donors substantially differ from those allocated by WHO member states. The meeting at Bamako provides an opportunity to consider how this disparity might be addressed. Funding None.

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Who Sets the Global Health Research Agenda? The Challenge of Multi-Bi Financing

Devi Sridhar (2012)

As part of a cluster of articles critically reflecting on the theme of “no health without research,” Devi Sridhar discusses a major challenge in the governance of research funding: “multi-bi” financing that allows the priorities of funding bodies to dictate what health issues and diseases are studied.

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Author and article information

Journal

Journal ID (nlm-ta): PLoS Med

Journal ID (iso-abbrev): PLoS Med

Journal ID (publisher-id): PLoS

Journal ID (pmc): plosmed

Title: PLoS Medicine

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Print): 1549-1277

ISSN (Electronic): 1549-1676

Publication date Collection: July 2013

Publication date (Print): July 2013

Publication date (Electronic): 23 July 2013

Volume: 10

Issue: 7

Electronic Location Identifier: e1001487

Affiliations

[1 ]School of Social and Political Sciences, University of Edinburgh, Edinburgh, United Kingdom

[2 ]Blavatnik School of Government, University of Oxford, Oxford, United Kingdom

[3 ]School of Population Health, University of Queensland, Brisbane, Australia

[4 ]O'Neill Institute for National and Global Health Law, Georgetown University, Washington, D.C., United States of America

[5 ]European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom

Author notes

* E-mail: Devi.sridhar@ 123456ed.ac.uk

The authors have declared no competing interest exists.

Wrote the first draft of the manuscript: DS. Contributed to the writing of the manuscript: DS CEB SD JE LOG PH MM. ICMJE criteria for authorship read and met: DS CEB SD JE LOG PH MM. Agree with manuscript results and conclusions: DS CEB SD JE LOG PH MM.

The Policy Forum allows health policy makers around the world to discuss challenges and opportunities for improving health care in their societies.

Article

Publisher ID: PMEDICINE-D-13-01036

DOI: 10.1371/journal.pmed.1001487

PMC ID: 3720248

PubMed ID: 23935458

SO-VID: 3665bfcd-2e22-4455-aedb-3bfe57822c29

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Page count

Pages: 6

Funding

Go4Health is a research project funded by the European Union's Seventh Framework Program, grant HEALTH-F1-2012-305240, and by the Australian Government's NH&MRC-European Union Collaborative Research Grants, grant 1055138. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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