Meaningful Accountability in Global Health

Jason Wright

Health Programs Group Senior Director, Project Implementation (and former LMG Project Director)

Jason Wright is the Director of the Leadership, Management, and Governance Project.

On November 19, in Washington, DC, I spoke on a plenary panel titled “Meaningful accountability: Rethinking roles and responsibilities in the SDG era” at the annual Global Health Council (GHC) Landscape Symposium sponsored by Management Sciences for Health (MSH) and other organizations. Currently, MSH President and Chief Executive Officer Jono Quick chairs the GHC Board, and I co-chair the Board's Membership and Development Committee.

2015 Global Health Landscape Symposium. (Photo: MSH Staff)

The symposium theme was "Achieving Universality in Global Health: An Imperative for Change," and provided “a high-level forum for exploration, debate and creative thinking on how we must collaborate differently in the post-2015 landscape with a focus on effective organizational responses and innovative solutions.”

Joining me for “Meaningful Accountability” were panelists Nancy Wildfeir-Field, President of GBCHealth, and Ariel Frisancho, the Peru Country Director for the Catholic Medical Mission Board; and Jen Kates, the Vice President and Director of Global Health and HIV Policy for the Kaiser Family Foundation, moderated the conversation. Our discussion on accountability covered issues on civil society, universality, and corruption within the health sector.

Challenges Facing Civil Society

Civil society organizations (CSOs) serve two roles as watchdogs and implementers. The relationship between these dual roles contributes to perceived and real conflicts of interest that must be mitigated. Since CSOs and faith-based organizations provide more than half of healthcare services in some countries, accountability mechanisms must be designed to avoid reinforcing existing power imbalances between government and civil society, and the bilateral, multilateral, and private sector organizations working to address those imbalances.

Disaggregate Data for Universality

Similarly, as we enter the sustainable development era, disaggregated data is needed to hold the global community accountable to the Sustainable Development Goals (SDGs) and for universality. To achieve the SDG targets, data must be disaggregated by gender and population group. During my tenure as U.S. Director of the International HIV/AIDS Alliance, I championed the need for disaggregated data for key populations—including men who have sex with men, transgender persons, sex workers, and persons who inject drugs—in the development of the UNAIDS 90-90-90 targets and in pursuit of truly universal health coverage.

Accountability and Corruption

On issues of accountability and corruption in the health sector, I highlighted the 2013 report on “Corruption in Health Sectors of Low- and Middle-Income Countries.” The survey reflects the diverse stakeholder perspectives: both across civil society, government, private sector, and academia; and from 95 countries.

The report effectively synthesizes five health sector areas that are most vulnerable to corruption, five expressions of corruption, and these five strategies to reduce corruption:

  1. Enhance awareness and transparency;
  2. Develop health leadership and management;
  3. Promote enforcement, detection, and prosecution;
  4. Improve incentive for health workers to provide quality care; and
  5. Strengthen ethics training programs.

Corruption in the health sector has consequences. For example, during my Global Fund Board experience with the Office of the Inspector General, a crisis initiated by a January 2011 Associated Press article on fraud in four countries prompted Germany and the European Commission to suspend contributions. The Board was forced to accept recommended reforms from a High-Level Independent Review Panel on Fiduciary Control and Oversight Mechanisms, and the Global Fund has since established a Chief Risk Officer position and developed a Risk Management Policy

Silos in the Health Sector – “A Hard Nut to Crack”

Furthermore, to truly breakdown silos in the health sector, a balance between national health sector and disease strategies must exist. For example, the International Health Partnership Plus (IHP+) related initiatives developed the Joint Assessment of National health Strategies (JANS) approach to:

  • Enhance the quality and relevance of the national health strategy;
  • Increase confidence in the strategy and help inform decisions about funding, ensuring that funding is closely aligned to the national health strategy; and
  • Reduce transaction costs at the country level and cut down multiple assessments and review processes by different agencies.

However, health sector strategies unfortunately lack the level of detail necessary for bilateral and multilateral donors to make informed funding decisions for particular diseases or conditions.

Independent Review Bodies in the SDG Era

Both funding and accountability mechanisms must include multiple relevant stakeholders. The UNAIDS Program Coordinating Board (PCB) is unique among the governing bodies of U.N. agencies by including a Non-governmental Organization (NGO) Board delegation, while other U.N. agencies are purely intergovernmental with NGOs holding only observer status. The Global Fund Board includes both donors and implementers, with three delegations for civil society (Communities, Developed Country NGO, and Developing Country NGO), one delegation for Private Foundations (Jen is the Alternate Board Member for Private Foundations), and one for the Private Sector, and the Global Fund also utilizes independent review through its Technical Review Panel (TRP), which reviews Concept Notes and makes funding recommendations to the Board.

Building an Inclusive World

One major highlight from the symposium—that came during an early plenary—was the official launch of the Women Leaders in Global Health Initiative (WLGHI) by GHC Executive Director Christine Sow. GHC frames the initiative this way:

Women make up the vast majority of those working in the field of global health, but are seriously underrepresented at the institutional decision-making level, in global policy and governance forums, and in thought leadership panels and venues. Inequity continues to be pervasive at the highest levels, demonstrated by the recent 68th World Health Assembly (WHA) of the World Health Organization (WHO) where only 23% of chief delegates of member state delegations were headed by women.

The vision of WLGHI is “a world where women are represented in equal numbers to men at the highest levels of decision-making and visibility, and its mission is to address the individual, institutional, and political challenges that impede women’s positioning as leaders in global health through strategic advocacy, networking, mentorship, and capacity building.”

Meaningful accountability is everyone’s responsibility. As we aim high and look toward 2030, ensuring universal health coverage will reflect the global health community’s due diligence to build clear roles, responsibilities, and expectations in 2015 and 2016.