1. Evolution of Global Health Landscape – its architecture and governance

2. What is Global Health? “Health issues where the determinants circumvent, undermine, or are oblivious to the territorial boundaries of states, and are thus beyond the capacity of individual countries to address through domestic institutions. It focus on people across the whole planet. It recognizes that health is determined by problems, issues and concerns that transcend national boundaries.” Global Health involves all partners from government, communities, to foundations, NGOs and private sectors. 2

3. Global Health and International Health InternationalGlobal Health ScopeConventional Health Care issues Extend to Social Determinants of Health, Trade, Climate change, Security ActorsGovernment health sector technocrats Extend to other sectors, Private Sector, NGOs, GHPs Foundations, Academia Influencing Instruments Constitutions, Regulations, Conventions Other soft laws, financial and trade, Social and intellectual

4. Four major challenges on GH structures Globalization – freer flow of people, investments, goods and services and information Emergence of new actors - especially other sectors, NGOs, private sector and GHPs competing with existing IGOs, even normative functions The shifting geopolitical order including the formation of regional bodies and likeminded clubs, e.g. BRICS, FPGH, ASEAN Funding structure – more donors’ influences 6

5. Five metaphors about Global Health GH as foreign policy – trade, democracy, economic growth, image, destabilize countries GH as security – bioterrorism, pandemic, AMR, MDR, HIV GH as charity – fight poverty, philanthropy GH as investment – economic development – Medical tourisms, infectious diseases GH as public health – maximize health effect – FCTC, IHR, UC, HR migration, AMR, MDR TB, HIV, etc

6. Global Health Players - not only WHO UN: WHO, ILO, UNICEF, UNFPA, UNAIDs, WTO, WB Donors: JICA, USAID n PEPFAR, DFID, EU/EC, G8/G20 Foundations: BMGF, RF, CMB, Wellcome Trust.. INGOs: MSF, Oxfam, Clinton foundation.. Global Health Partnerships: GAVI, GF, … Private Sector – drugs, foods, tobacco, alcohol… Emerging MICs – more than 100 countries, 5/7 of pop

7. Crowded Global Health Landscape 4 9

8. Who influence Global Health Partnerships – Northern Global Actors and private sector?? ( analysis of 298 board seats of GHPs) 4 (Little contribution but high representation) (so small?) Influence of WHO as compare to private sector and BMGF???? (mainly BMGF) 11

9. Global Health Financing – two decades Global Fund This is only 6% of total national health spending and 26% in low income countries Direct Bilateral UN GF/GAVI

10. 10 WHO budget: assessed and voluntary contribution 1998-2013

11. Top ten WHO donors (voluntary contribution) 2010-2011 11 DonorsNon earmarked%Earmarked%Total 1. Gates00% 446,161,801100% 446,161,801 2. USA 00% 438,285,683100%438,285,683 3. UK 41,009,71814% 247,942,67586% 288,952,393 4. Canada00% 154,147,294100% 154,147,294 5. Rotary00% 116,565,898100% 116,565,898 6. Norway 47,925,89642% 65,963,66658% 113,889,562 7. UNDP00% 109,890,218100%109,890,218 8. GAVI00% 98,782,852100% 98,782,852 9. Australia 28,717,11531% 63,097,75769%91,814,872 10. UN CERF00% 90,809,419100% 90,809,419

12. Strengths 1.Social Credit as Global Normative Bodies 2.Unlimited access to the best global experts 3.Extensive networks of WHO Regional and WROS 4.Only legitimate body for PHEIC (like Ebola) Weaknesses 1.Bureaucratic Systems – vertically and inefficient 2.Increasingly politicized 3.Outdated regional structures 4.Changing budgetary structures 5. Loss of global PH spirits – loss of good people 12 Strengths and Weaknesses of WHO

13. Concrete examples Brazil appoints their Chief of Global Relation in the MoPH from DDG level of the MFA SA has two health attache one in DC and the other in Geneva Most developed countries has health attache in many strategic countries Many donors now have ‘Health Ambassadors’ and also Global Health Policies/Strategies, division in MFA