Understanding the political economy of reforming global health initiatives – insights from global and country levels

Bibliographic Data

ID19534580
AuthorsSophie Witter (0000-0002-7656-6188, Queen Margaret University), Natasha Palmer (0009-0007-5875-5827, Queen Margaret University), Rosemary Jouhaud (University of Geneva), Shehla Zaidi (0000-0001-7620-9247, The George Institute for Global Health), Séverine Carillon (0000-0001-9487-7433, Cheikh Anta Diop University), René English (0000-0002-1563-2532, Stellenbosch University), Giulia Loffreda (0000-0003-4895-1051, Queen Margaret University), Ethel Venables (0000-0002-6647-380X, University of Geneva), Emilie Venables, Shifa Salman Habib (0000-0002-4531-8472, Aga Khan University), Jeff Tan (0000-0001-7013-1485, Aga Khan University), Fatouma Hane (Cheikh Anta Diop University), Maria Paola Bertone (0000-0001-8890-583X, Queen Margaret University), Seyed-Moeen Hosseinalipour (0000-0003-2109-5136, University of Geneva), Valery Ridde (0000-0001-9299-8266, Inserm), Asad Shoaib (Aga Khan University), Adama Faye (0000-0002-7849-2469, Cheikh Anta Diop University), Lilian Dudley (0000-0001-5370-1562, Stellenbosch University), Ken Daniels (0000-0002-4345-5406, Stellenbosch University), Karen Daniels (0000-0002-6604-1353), Karl Blanchet (0000-0003-0498-8020, University of Geneva)
Year2025
Volume21
Issue1
Pages40-40
Publication date2025-07-09
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueGlobalization and Health (JOURNAL)
Journal identifiersISSN: 1744-8603 • E-ISSN: 1744-8603
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/s12992-025-01129-0
PMID40634945
OpenAlexW4412177997
LanguageEN
Citations received5
References cited48

INTRODUCTION: Since 2000, the number and role of global health initiatives (GHIs) has been growing, with these platforms playing an increasingly important role in pooling and disbursing funds dedicated to specific global health priorities. While recognising their important contribution, there has also been a growth in concerns about distortions and inefficiencies linked to the GHIs and attempts to improve their alignment with country health systems. There is a growing momentum to adjust GHIs to the current broader range of global health threats, such as non-communicable diseases, humanitarian crises and climate change, and against the backdrop of the recent aid cuts. However, reform attempts are challenged by the political economy of the current structures. METHODS: In this article, we draw on research conducted as part of the Future of Global Health Initiatives process. The study adopted a cross-sectional, mixed-methods approach, drawing from a range of data sources and data collection methods, including a global and regional level analysis as well as three embedded country case studies in Pakistan, South Africa and Senegal. All data was collected from February to July 2023. 271 documents were analysed in the course of the study, along with data from 335 key informants and meeting participants in 66 countries and across a range of constituencies. For this paper, data were analysed using a political economy framework which focused on actors, context (especially governance and financing) and framing. FINDINGS: In relation to actors, the GHIs themselves have become increasingly complex (both internally and in their interrelations with other global health actors and one another). They have a large range of clients (including at national level and amongst multilateral agencies) which function as collaborators as well as competitors. Historically there have been few incentives for any of the actors to maximise collaboration given the competitive funding landscape. Power to exert pressure for reforms sits ultimately with bilateral and private funders, though single-issue northern non-governmental organisations (NGOs) are also cited as important influencers. Funders have not collaborated to enable reforms, despite concerns amongst a number of them, because of the helpful functional role of GHIs, which serves funder interests. Some key global boards are reported to be engineered for stasis, and there are widespread concerns about lack of transparency and over-claiming (by some GHIs) of their results. Framing of narratives about achievements and challenges is important to enable or block reforms and are vigorously contested, with stakeholders often selecting different outcomes to emphasise in justifying positions. CONCLUSION: GHIs have played an important role in the global health ecosystem but despite formal accountability structures to include recipient governments, substantive accountability has been focused upwards to funders, with risk management strategies which prioritise tracking resources more than improved national health system performance. Achieving consensus on reforms will be challenging but current funding pressures and new threats are creating a sense of urgency, which may shift positions. Political economy analysis can model and influence these debates

Comparative politics · Development economics · Economic growth · Economic system · Economics · Global politics · Health care · Health services research · International political economy · Political economy · Political science · Politics · Public health · Quality of Life Research · Social policy · Global Health and Surgery · Global Maternal and Child Health · Global Public Health Policies and Epidemiology · Medicine