Timothy G. Evans
Health and Human Rights 15/1
Published June 2013
In the last two decades, the mushrooming of global health partnerships, alliances, funds and initiatives accompanied by a shift in the resource psyche from millions to billions has been exciting but also bewildering. The landscape of global health is no longer defined primarily by multilateral institutions comprised of member states, but has been forced to expand to consider new types of international institutions with constituency representation from the private sector, civil society, academia, and philanthropy. Complex challenges like those related to pandemic flu, health worker migration, or HIV/AIDS are demanding intensive, intersectoral coordination and negotiation for which most institutions are ill-equipped to manage. From a governance perspective, it has challenged all institutions to rethink their roles and positions in a new global reality of health interdependence in which there is no single leader, issue, or comparative advantage that one institution can claim exclusively as their own. Not surprisingly, in the midst of such rapid change, which some have referred to as “open source anarchy” questions such as “who runs global health?” are leading to calls to reform multilateral institutions such as WHO and to rethink the global health architecture or governance.1-4