You scratch my back, I’ll scratch yours


The past decade has been dedicated to global health; with an increase in resources and advances in technology, millions of lives were saved or improved.  Health is an issue that involves several stakeholders from a range of sectors, both health and non-health. The future of global health is going to rely on taking on a more horizontal approach, reliant on on shared responsibility and mutual accountability with non-health sectors and national and local governments (not just the Ministry of Health).  Crucial to shared responsibility is leadership and strategic direction for the use of in-country resources and technologies, adopting “country ownership” and “accountability”.  Achieving country ownership requires good governance, a results-based approach, and the engagement of all sectors of society[1]. Each sector can benefit from one another, if they take the “you scratch my back, I’ll scratch yours” approach.

 Health sectors, governments, and other non-health sectors are ultimately responsible for the health of their people. In order to effectively accomplish this responsibility, policies must be set at the local and national level. The policies frameworks must be developed, planned and designed using contribution and commitment from relevant departments, ministries, and non-governmental stakeholders in order to achieve the health of individuals and communities. In order to influence and involve as many people as possible, it is important to engage community, religious, and private-sector leaders whom can help promote changes in behaviors and educate pertinent health issues in areas such as family planning, reproductive health, vaccinations, and stigma and discrimination. When considering the public good it is essential to cast a wide network.

By building a wide network within a community, civil society has proven to play a key role in advocating for increased resources for health and in ensuring accountability and transparency. In Botswana, the FHI 360 project, Maatla, “strengthens civil society to effectively address HIV and AIDS, strengthening the capacity of civil society to support the delivery of services for HIV and other health challenges”[2]. In a time of scarce and limited resources, it is crucial that accountability and transparency be clearly defined in the foundations of all future global health activity. As mentioned above, all partners (health and non-health sectors) must be accountable to each other. Be it funders, implementers, policy-makers, technical and support advisors, everyone involved from the global to the individual level must be engaged and accountable. The future of global health relies heavily on setting achievable targets, identifying these targets through a multidisciplinary lens will allow a more comprehensive understanding of what is expected. Involving a variety of sectors from the beginning will inform all stakeholders and partners making them more likely to support and commit. Big ideas can be pursued but it will take the commitment and follow through of all stakeholders, global to individual. To maximize accountability and transparency, it will require all stakeholders to be involved in the design, planning, and monitoring and evaluation of new goals, targets, and policies.

 A chief component of accountability is responsibility. We have a right to get the health care we need, and a responsibility to ensure that everyone else can do the same. Health and non-health sectors need to come together to support health care systems that are equitable, accountable to the people and that consider health care a public good, not a commodity. Too often, human rights function as a framework for making commitments that cannot be met without concrete plans, financial commitments or institutions to ensure they are achieved. Human rights have been the foundation of developments in global health and the founding of the World Health Organization (WHO). It is crucial to maintain the importance of human rights in any discussion of access to healthcare. It is equally important to provide policy space that respects the model of universal access while outlining achievable goals to create global and local institutions capable of provide it. The future of global health is a shared responsibility and need to take a global, horizontal approach including all stakeholders as a partnership not abdication.

Global health is at the top of political agendas across the world. The increased interdependence of health, education, economic, social, and environment interactions is increasingly understood. The future of global health is going to rely heavily on incorporating health into all policies, not only health sectors. To have a greater influence in coming years, the health sector needs to increase collaboration with multiple sectors.

[1] Dybul, M. Frenk, J. & Piot, P. “Reshaping Global Health”.  Hoover Institute, Stanford University. 1 June 2012. <>


[2] “Maatla—Botswana Civil Society Strengthening Program”. Projects. FHI360. Date Accessed 7 December 2013. <>

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