Global Governance: The Current Landscape of Development Assistance

According to researchers at the Institute for Health Metrics and Evaluation (IHME), development assistance for health (DAH) is estimated to have peaked in 2013 at approximately $31.3 billion, five times greater than in 1990. According to the World Health Organization, half of additional funding between 2000 and 2009 targeted two diseases —malaria and the human immunodeficiency virus (HIV). As new players continue to enter the DAH landscape, the global health community must strategically address the underlying demands for effective global governance.

Stewart Patrick of the Council on Foreign Relations, discusses the evolvement of global governance in the light that, “Global cooperation is increasingly occurring outside formal institutions, as frustrated actors turn to more ad hoc venues.” Indeed, the diversified landscape of donors today include—emerging bilateral donors, multilateral donors, global funds and alliances, non-governmental organizations (NGOs), private philanthropies, and the private commercial sector. Given this vast plethora of global health investors, it’s inevitable that there is a co-evolving shift of power and politics.

The potential harms involved with a variable donor landscape include growing gaps in population health outcomes for recipient countries, disproportionate funding based on donor priorities versus actual burdens of disease, and issues of inequitable membership and voting power for developing countries. Perhaps there are too many powerful voices that are crowding out the powerless. Sridhar and Batniji’s analyses of major worldwide health donors at the forefront of DAH (e.g. the World Bank, US Government, the Bill & Melinda Gates Foundation, and the Global Fund) suggest three key issues for the global health community: 1) the major data gap in donor disbursements and commitment; 2) the need for communicating country ownership in priority setting; and 3) the need for equitable global health financing through the imagery of a global health governance patchwork of donors, UN agencies, governments, civil-society organizations, and the private sector.

The complex realm of international aid may benefit by shifting to “minilaterlism”—bringing together the smallest number of parties necessary to have a positive impact on a given problem, as a consumable short-term approach. Nonetheless, the substantial increase and attention on global health funding holds important implications for sustainable global governance through improved coordination, infrastructure, transparency, and accountability among stakeholders on all fronts of development assistance.

1. Bloom BR. WHO needs change. Nature. 2011 May 12;473(7346):143-5.
2. Grépin KA. HIV donor funding has both boosted and curbed the delivery of different non-HIV health services in sub-Saharan Africa. Health Aff (Millwood). 2012 Jul;31(7):1406-14.
3. Sridhar D1, Batniji R. Misfinancing global health: a case for transparency in disbursements and decision making. Lancet. 2008 Sep 27;372(9644):1185-91.


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