Health systems and the new global architecture

Recent research undertaken by Johanna Hanefeld has included a focus on how health systems can adapt and respond to increased patient mobility and migration. This has spanned work in the UK, Thailand and most recently in South Africa. Research funded by MRC/DFID/ESRC/Wellcome Trust Joint Health Systems Research Initiative and undertaken with the Africa Centre for Migration and Society at the University of Witwatersrand focused on how patient mobility and migration affect health systems and outcomes in maternal and child health. Work has also examined how global guidelines are translated to national level in Uganda and Ghana, taking the examples of WHO treatment Guidelines and, in partnership with Imperial College London, the UNAIDS 90-90-90 target. Questions asked include: how do the actions and interests of global health actors influence what happens at clinic level? By which processes are internationally defined targets translated, and how can the global policies and actors best support those implementing programmes at national and local levels to achieve universal coverage, to ensure health systems are more resilient to shocks and more people-centred.

Historical perspectives on international policy towards health systems. There are many agencies today, including WHO, the World Bank, and NGOs for whom health systems are a global health priority. However, for many low-income countries early experiences of development began as impositions during the colonial era. Since decolonisation, planning has led both to successes, where political will and resources have aligned, and failures, due to misplaced optimism and poor understanding. Staff at the Centre for History in Public Health are applying historical analyses to health systems. Wellcome Trust funded projects include: The politics of international health system metrics, 1924-2010 (Martin Gorsky, Chris Sirrs); the rise and fall of health system planning in post-colonial Africa (John Manton, Martin Gorsky); and the Idea of a Health System: its Application in International Health Policy, with reference to the African and Western Pacific regional offices of the WHO (John Manton). National studies are ongoing in Nigeria, China, The Philippines, Britain and New Zealand.

Using a governance and accountability lens, the Climate Governance project led by Susannah Mayhew examined the accountability and responsiveness of global intergovernmental agencies to climate change challenges and the framing of “health” within this discourse. It examines interactions between institutional structures and policies and the influence of individual leaders and their discourse both at the helm of institutions but also at middle -management levels. They also examined accountability, including the changing pressures from client countries and member states on climate change action.


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