Early View Article - Gridlock, Innovation and Resilience in Global Health Governance

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Global health governance is in many ways proving more innovative and resilient than other sectors in global governance. In order to understand the mechanisms that have made these developments possible, this article draws on the concept of gridlock, as well as on the additional theoretical strands of metagovernance and adaptive governance, to conceptualize how global health governance has been able to adapt despite increasingly difficult conditions in the multilateral order. The remarkable degree of innovation that characterizes global health governance is the result of two interrelated conditions. First, developments that are normally associated with gridlock in multilateral cooperation, such as institutional fragmentation and growing multipolarity, have transformed, rather than gridlocked, global health governance. Second, global health actors have often been able to harness the opportunities offered by three important pathways of change, namely: (1) a significant degree of organizational learning and active feedback loops between epistemic and practice communities; (2) a highly polycentric system of governance; and (3) the increased role of political leadership as a catalyst for governance innovation. These trends are discussed in the context of three case studies of significant political, social and health relevance, namely HIV/AIDS, the 2014 Ebola outbreak and antimicrobial resistance.

Policy Implications

  • The WHO should not seek to separate its normative and technical function from its convening and leadership function in order to re‐assert its authority as the core institution of global health governance.
  • The use of effective interorganizational coordination mechanisms need to be expanded, with emphasis on areas such as environmental health and non‐communicable diseases, or strengthened when already in place (such as in AMR), given that most current and emerging health challenges now require action beyond the health sector.
  • Raising the political profile of health challenges requires the consideration of the conditions under which doing so might foster significant progress. It is necessary to form inclusive alliances which coalesce around common goals and norms and bring together different types of actors.
  • The funding strategies of actors including multilateral development banks and private foundations must increasingly shift from vertical disease programmes to health system strengthening objectives, including universal health coverage and greater attention to the determinants of health.
  • International efforts aimed at generating buy‐in by developing country actors on global health initiatives will have to be complemented by a stronger emphasis on using political leadership to create ownership at the domestic level, filling the persistent implementation and capacity gap that many countries still face.