How to Break the Gridlock in Global Health Governance

To what extent does the concept of gridlock apply to the global health governance and account for its deficiencies? What is the potential for reform?

Project Summary

Over the last twenty years, available funding for global health and the number of global health actors have both increased exponentially, making it one of the most dynamic and innovative arenas of global governance. This being said, the Millennium Development Goals related to health have largely gone unmet (UN 2013) and health crises such as the recent Ebola outbreak have powerfully underscored the fact that increased number of institutions and funding streams have not translated into sustainable health systems, effective governance, or decisive global health leadership. Indeed, this proliferation of actors and institutions has led to fragmentation, competition, and – in a word – “gridlock” in global health governance.

Gridlock is the tendency to stall in pressing international negotiations and describes the breakdown of the major tools of global policy making. Gridlock decreases the ability of international actors to coordinate effectively at a time when there is increased interdependence and need for collective action to protect global public goods.

This project seeks to operationalise the concept of gridlock to account for the deficiencies in global health governance and to illuminate the potential for reform. It will explore if, and how, the four pathways to gridlock (i.e. growing multipolarity, institutional inertia, harder problems, and fragmentation) can be applied to global health. The research will bridge existing literature gaps and draw on studies conducted on gridlock in other areas of global governance (including security, environment, and the economy). The research team will conduct a comparative analysis to understand not only the pathways to gridlock in global health governance, but more importantly, how to break the gridlock.

Academic Output

Working Paper

How to Break the Gridlock in Global Health Governance? Innovation, Learning and Polycentricity in Global Health Governance

This paper has argued that the last three decades of global health governance have brought a remarkable degree of innovation, despite a wider geopolitical context characterized by increasing complexity and interdependence. This has been made possible by two interrelated conditions. First, growing multipolarity and institutional fragmentation have effectively transformed, rather than gridlocked, global health governance, changing the structural context in which the rules are formed and the solutions deployed without simultaneously preventing meaningful governance innovations from taking place. Secondly, global health governance has increasingly assumed the characteristics of a highly adaptive system in which the presence of self-reflexive learning processes, a polycentric governance structure, and the emergence of vocal political leadership constantly combine in the creation of pathways of change.

Executive Summary

This research project examined gridlock in global health governance. It has drawn on the gridlock theory by Hale et al. (2013) and went beyond its initial conceptualization. Three particular case studies, HIV, Ebola and Antimicrobial Resistance (AMR), have been selected in order to better understand the underlying governance dynamics. The last three decades of global health governance have brought a remarkable degree of innovation in a geopolitical context characterized by increasing complexity and interdependence. Growing multipolarity and institutional fragmentation have effectively transformed, rather than gridlocked, global health governance, changing the institutional context in which the rules and solutions are set. Therefore, the health domain can be characterized as a highly adaptive system in which self-reflexive learning processes, a polycentric governance structures, and the emergence of vocal political leadership are possible.

Article

Gridlock, Innovation and Resilience in Global Health Governance

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.

Research Team

Ilona Kickbusch
Coordinator
Graduate Institute Geneva

Michaela Told
Co-Coordinator
Graduate Institute Geneva

Gian Luca Burci
Principal Member
World Health Organisation (WHO)

Stefan Germann
Principal Member
World Vision International

David Held
Principal Member
University of Durham

Kyle McNally
Principal Member
University of Durham

Dario Piselli
Principal Member
Graduate Institute Geneva

Srikanth Reddy
Principal Member
Graduate Institute Geneva

David Evans
Associated Member
Swiss Tropical and Public Health Institute

Eleanor Hutchinson
Associated Member
Other

Lelio Hernan Marmora
Associated Member
UNITAID International drug purchase facility

Jonathan Patz
Associated Member
University of Wisconsin-Madison

Albrecht Schnabel
Associated Member
DCAF Geneva Centre for the Democratic Control of Armed Forces

Peter White
Associated Member
World Business Council for Sustainable Development

Status

completed

Disciplines

Themes

Regions

Countries

All countries

Host Institution

Coordinator

Year