Governing Global Health: Who Runs the World and Why?

The past few decades have seen a massive increase in the number of international organizations focusing on global health. Campaigns to eradicate or stem the spread of AIDS, SARS, malaria across the world, and Ebola in West Africa attest to the increasing importance of globally-oriented health organizations, which have dedicated significant people and resources to combat all of these crises. Some of these organizations are national, some are regional, some are international (often affiliated with the UN), and some are private non-state organizations, like Medicins Sans Frontieres. One of the more important recent trends in global health governance has been the rise of public-private partnerships (PPPs), where private non-governmental organizations, for-profit enterprises, and various other social entrepreneurs work hand-in-hand with governments to combat specific maladies. A primary driver for the increased presence of private actors in historically public spaces and even institutions is the widespread belief that each type possesses a different form of expertise, and that by joining together, PPPs will attack health problems more effectively and be able to fund shared efforts more efficiently. Indeed, another factor fueling the rise of PPPs has been the reluctance of governments to invest further in the UN system given difficulty in holding its agencies accountable and reforming them.

As Chelsea Clinton and Devi Sridhar show in Governing Global Health, these partnerships are not only important for combating infectious diseases; they also provide models for developing solutions to a host of other serious global health challenges and questions beyond health. But what do we actually know about the accountability and effectiveness of PPPs in relation to the traditional multilaterals? According to Clinton and Sridhar, we know very little because scholars have not accumulated enough data or developed effective ways to assess them. That is what they do here, and they have found that while the model has strengths, it has weaknesses as well. Using principal-agent theory, in which governments are the principals directing international agents of various type, they take a closer look at two major PPPs, the Global Fund to Fight HIV/AIDS, TB and Malaria and the GAVI Alliance, and two major more traditional international organizations, the World Health Organization and the World Bank. An even-handed and thorough empirical analysis of one of the most pressing topics in world affairs, Governing Global Health will reshape our understanding of how organizations can more effectively prevent the spread of communicable diseases like AIDS and reduce pervasive chronic health problems like malnutrition.