1. Global Health Governance

2. Issues and choices: Donors
• Thought exercise: Imagine you are working in a donor
institution and an applicant organization has requested
your support. Write down in one minute the words, eg,
priorities, budget, that characterize the areas about
which you would want to obtain information before
agreeing to provide support. Then check your terms
against those on the next slide.
2

3. •Priorities: How were they set, by
whom and based on what evidence?
•Objectives: Are they clear,
quantitative, realistic?
•Budget: How realistic and specific;
salaries, supplies, equipment?
•Recipient: Who receives & manages
the funds; what is their track record?
•Fund structuring: Grant, loan,
tranches, performance conditions,
etc?
•Organizational capacity: Numbers
& competencies of personnel;
administrative capacity; past
performance; risks of corruption, etc.
•Monitoring & evaluation: Provision
for data collection and analysis
•Country context: How does project
or program relate to other activities?
Compete, complement, synergistic,
no relationship, etc?
•Capacity-building: Aside from
specific objectives will assistance
strengthen overall institutional
capacity?
•Sustainability: Will project require
continuation funding and/or
complementary funding, and if so, for
how long?
Key issues for Donors
3

4. Issues and choices: Recipients
• Thought exercise: Now imagine you are seeking major
funding for a program in your low income country. Write
down in one minute the words that characterize your
concerns as you prepare your proposal. Then check your
terms against those on the following slide.

5. Key issues for Recipients
•Priorities: Are they locally derived or
in response to donor priorities?
•Local buy-in: Is there good local
support for the proposed activity?
•Flexibility: Can funding allocations
and activities be modified as experience
dictates or is the budget tightly fixed?
•Constraints: What limitations will be
imposed, e.g., equipment purchases
only from donor country, ‘gag order’
for abortion services?
•Monitoring and accounting:
Frequency and complexity of reporting
requirements? Compatibility or not
with existing data systems?
•Intrusiveness: Are foreign consultants
and/or evaluators required and if so, who
recruits, pays, directs, monitors and
terminates them?
•Compatibility: Does program
complement, complicate or compete
with work in other areas, e.g., taking
personnel away from other programs,
complicating administrative
relationships, etc?
•Political implications: Will donor
support have potentially positive or
negative repercussions?

6. Three major types of global health actors
1. Multinational organizations
A. Organizations within the UN system relevant to health
B. Organizations outside of the UN system relevant to
health
2. Bilateral -- government-to-government or to sub-
government levels
3. Non-governmental organizations (NGOs)

7. Multinational
• Organizations within UN system relevant to health
• WHO (World Health Organization, 1948)
• UNICEF (U.N. Infant & Children’s Emergency Fund,1946)
• UNFPA (Population Fund, 1967)
• UNDP (U.N. Development Programme, 1965)
• FAO (Food & Agricultural Organization, 1943)
• UNESCO (U.N. Educational, Scientific and Cultural
Organization, 1945)
• UNHCR (U.N. Refugee Agency, 1950)
• WFP (World Food Programme, 1962)
• UNODC (U.N. Office on Drugs & Crime, 1997)

8. • Organizations outside the UN relevant to health
• U.N. Affiliated Programs
– Banks: Global Fund to Fight AIDS, TB and Malaria, 2002
– UNAIDS (Joint U.N. Programme on HIV/AIDS, 1994)
– And many others
• World Bank Group, International Monetary Fund (IMF)
• Others: World Trade Organization
Multinational

9. Bilateral Aid Agencies*
• Many of the “rich” 34 OECD countries have official, government
owned or controlled aid agencies, e.g.,
– USAID (U.S. Agency for International Development)
– DFID (U.K.)
– SIDA (Sweden)
– CIDA and IDRC (Canada)
– DANIDA (Denmark)
– JICA (Japan)
– And many others
*”Bilateral” nominally refers to aid assistance provided by one government to another government. In practice a
donor government may provide funding to NGOs within its own borders, and these then provide assistance to
organizations within the recipient countries. Governments can also provide assistance directly to NGOs and other
entities in the recipient countries. For example, USAID provides large contracts to US NGOs to provide capacity-
building services and tools to recipient countries.

10. Bilateral Aid Agencies
US Government: Agencies with Global Health Activities
• Dept. of Health & Human
Services (DHHS)
– Centers for Disease
Control & Prevention
– National Institutes of
Health
– Health Resources and
Services Administration
– Food & Drug
Administration
• Dept. of Defense
• Department of State
– USAID
– PEPFAR
– Peace Corps
• Millennium Challenge
Corporation
• President’s Malaria Initiative
• Dept. of Homeland Security
• Dept. of Agriculture
• US Trade Representative

11. • NGOs defined by their
extraordinary diversity:
 Non-profit and profit-
based
 Religious and secular
 Narrow and broad scope
programs
 Wealthy and shoe-string
operations
 Big NGOs are called
BINGOs
 Well paid, marginally
paid and volunteer staff
 Long- and short-term
commitments
 Single-country, multi-
country and regional
focus
 Single problem and
multi-problem focus
 Single sector and multi-
sector focus
 Emergency relief and
development focus
Non-governmental organizations (NGOs)

12. Charitable (secular) organizations
• Oxfam
• CARE
• Save the Children/UK (& US)
• International Red Cross
• Doctors without Borders
• Project Hope
• International Rescue Committee
• CARE
• Freedom from Hunger
• Child Family Health International
• Doctors for Global Health
Non-governmental organizations (NGOs)

13. Faith-based organizations (FBOs)
• Catholic Relief Services
• Christian Aid
• Lutheran World Relief
• Unitarian Universalist Service Society
Non-governmental organizations (NGOs)

14. Philanthropic foundations
• Bill & Melinda Gates
• Atlantic Philanthropies
• Carnegie
• Rockefeller
• Clinton Global Initiative
• Carlos Slim
• Josiah Macy, Jr.
• Kellogg
• Ford
• MacArthur
• Seva
Non-governmental organizations (NGOs)

15. Membership organizations
(including their international /global health sections)
• Global Health Council
• American Public Health Association
• American Academy of Family Physicians
• American Academy of Pediatrics
• Rotary International
• Global Health Education Consortium
Non-governmental organizations (NGOs)

16. Consulting /contracting organizations (PVOs)
• John Snow International
• Management Sciences for Health
• Abt Associates
• IntraHealth International
• Family Health International
• Academy for Educational Devt.
Non-governmental organizations (NGOs)

17. Academic institutions
Rapid increase in global health centers & programs
– A 2010 CUGH survey found >200 such programs
– Involvement in training, research, service
Some major university programs
– Duke University
– Emory University
– Oxford University
– Harvard University
– Vanderbilt University
– University of Toronto
– University of Washington
– Johns Hopkins University
– Univ. of Calif. at San Francisco
– London School Hygiene & Tropical Medicine

18. Interventions to tackle Governance of the Health System
Directly address public sector
performance
• Capacity development
• Institutional review and
strengthening
• Improved information and
communication
• Management systems revamped
• Partnership and coalition
• Instill sense of greater
accountability to populations
Stakeholders monitor public
sector performance
• Organized and empowered
communities
– democracy, devolution
• Civil society and media have a
'watch dog’ function
• Academia
– Generate &synthesize evidence
– Communicate to decision
makers
• Medical and paramedical
associations
– Voice and accountability
• Revamped legislative and judicial
system e.g. Medical negligence