Private Actors in Global Health Governance

Abstract

The landscape of global health governance has undergone a radical transformation. Perhaps the most striking change has been the rise of private actors and their incorporation into what was previously a publicly dominated governance system. Their rise to prominence in global health has brought many benefits, not least in the vast resources that they have harnessed for addressing key global health problems. Yet they have attracted criticism as well as praise. The fact that there have often been heated debates surrounding the roles of global health partnerships (GHPs) and philanthropic foundations is testament to the simple fact that something fundamental has taken place in the field of global health. In a relatively short period of time, beginning in the mid-1990s, these actors have revolutionised the health governance architecture to an extent that the wider international system has not witnessed since the creation of the modern multilateral system, in the aftermath of the Second World War. In contrast to those earlier seismic shifts in international governance, the entrance of private actors in global health governance has not been the result of a carefully planned process. There has been no equivalent of the San Francisco or Bretton Woods Conferences. Rather, the change in global health governance has been a gradual and often ad hoc process. There are no clear lines of authority, either politically or legally. Mandates often overlap and compete. Traditional governance actors, from states to the World Health Organization (WHO), have been forced to adapt to this new reality.