Author: Tegan Mosugu, Victor Zacchaeus and John Ijaja

Type of publication: Article

Link to the original document

Understanding Effective Health Governance

Concerted global health efforts are dependent on communication between humans across a plethora of social domains – economic, political, technological, cultural and environmental. These globalizing changes are gradually diminishing boundaries that before now, separated humans from each other. Thus, globalization increases many health challenges and by so doing, limits the ability of governments to respond to crisis. It is important to note that globalization catalyzes and facilitates innovation. It is therefore pertinent to stimulate new actors to innovate by developing new ideas, approaches, and institutions. Collective action can capitalize on globalization by being an effective tool in curbing the negative impacts of globalization on global health governance. Smith & Lee suggest that collective action in a globalized world requires institutions that look very different from what is currently in place. Instead of renovating outdated institutional forms, -which are constricted by fixed territories, autonomy and social scale-more ingenious approaches should be employed with the purpose of effectively mitigating transboundary risks to achieve the common goal of a safe and healthy society. The capacity of national health systems to protect and promote the health of their citizens is jeopardized by population mobility. This is because globalization is characterized by an increase in the number, and level of influence of forces beyond national borders including migration and population mobility–a great determinant in the spread of emerging/reemerging infectious diseases and noncommunicable diseases. The rapid spread of the virus corroborates the notion that globalization overshadows national boundaries; thus, calling for the need for collective action and multilateral policies during pandemics.

In recent times, it has become more apparent that the world needs scientific solidarity and strong moral leadership during infectious disease outbreaks. One of the major forms of institutional innovation is ‘network governance’, by which collective action is achieved through interconnected institutions spanning government, business and civil society. Network governance is a form of organizational alliance in which relevant policy actors are linked together as co-producers where they are more likely to identify and share common interests”. These networks form synergies across various levels of skill, experience and expertise in order to deal with complex problems. In addition, they also mobilize resources and co-produce policy interventions with other stakeholders. Opportunities abound for world health governance to draw on such samples of institutional innovation. For instance, the ‘sharing economy’, whereby individuals worldwide rent accommodation, vehicles and other assets directly from one another through on-line transactions, would possibly facilitate how people tend to invest in, and share, major assets that benefit health across countries, such as laboratories, computer technologies and knowledge sources.

Public health governance must be strengthened through joint research platforms, health networks, and integrated surveillance systems. This fosters collaboration between NGOs and national governments as they work to achieve national public health goals. Leaving the burden of disease monitoring, intervention and research development to governments alone would likely lead to a failed state. Thus, different actors from different backgrounds and sectors need to pull resources and expertise together to attain a common goal. Some of the advantages of such forms of network coordination in governance include improved learning, increased ability to tackle complex issues, and efficient use of available resources.

In Taiwan, effective reporting through contact tracing as well as data monitoring has led to a lower incidence rate of COVID-19. Typical features of infectious disease threats can also be made known earlier due to effective reporting. Infectious diseases are heavily dependent on the timing of the occurrence, duration, and the path of development. Ultimately preparing for these threats save lives and also lead to a more robust health system that is equipped across different dimensions on the centralized and decentralized level. However, effective reporting is not just a one-stop solution to counteracting the spread of an infectious disease. Effective reporting must be coupled with an understanding of the crisis. A deeper understanding of existing threats would help guide the responses needed to protect individuals at the household, community, and national level. In Guyana, The Civil Defense Commission through the National Emergency Operations Centre (NEOC) engaged several non-governmental organizations and international agencies to beef up networking, and partnerships in the fight against COVID-19. These agencies include National Emergency Operations Centre, Pan American Health Organisation/World Health Organization (PAHO/WHO), Rotary District, Food for The Poor Guyana, and several others.

The World Health Organization’s capacity to take up disease surveillance, monitoring and reporting has traditionally relied on information from member states – in this transboundary world, government institutions based on discrete populations located on fixed territories are increasingly irreconcilable. Global health has faced a succession of diseases reflecting a globalizing world – the AIDS pandemic, SARS, Ebola and Zika virus outbreaks all reveal that governments alone are unable to generate and deploy sufficient data, human capital and other resources in a timely manner. The COVID-19 pandemic has further shown that health governance is more of an inclusive activity involving different stakeholders and not just health practitioners. Effective health governance is a by-product of coordinated activities that stem from information symmetry. More than ever, institutions that bring together expertise and ideas from far and wide, are what the world needs as opposed to fixed, bureaucratic, and hierarchical structures which constrict how problems and their solutions are defined.

The roles of NGOs amid the pandemic

Throughout history, non-governmental organizations (NGOs) have served as a powerful voice for society’s most vulnerable and marginalized communities. Amid the COVID-19 global crisis, NGOs are highly essential in counteracting the impact of the pandemic through their humanitarian assistance and efforts. These organizations minimize suffering by allocating funds and emergency relief to at-risk communities, supporting health delivery efforts, and providing medicine and hygiene kits to those in need of it. Moreover, NGOs also promote the interest of the citizenry by acting as an information bridge between the people and donors. As a result, it is important to understand the transformative power that NGOs can have in wake of this pandemic. As pertinent building blocks of civil society, these organizations can improve service delivery outcomes and development by using bottom-up accountability processes to ensure that people get the necessary goods and services during periods of uncertainty.

NGOs have always helped in mitigating the effects of global health crises (whether health or political) on the people they serve. For example, during Ebola, NGOs supported the establishment of treatment centers and significantly contributed to preventing the spread of the virus through effective patient isolation measures. During pandemics, NGOs are positioned to serve people better through services that minimize suffering, promote the interests of the poor, provide basic social services, and strengthen community development initiatives. Although several NGOs currently face funding insecurities, there is still commitment to securing key local partners that can deliver essential services. These civil society actors collaborate with local partners and use their on-the-ground expertise as an absolute advantage to recognize potential threats that can plague communities.

Public service organizations, (particularly NGOs) are quickly assessing the situation on the ground by routinely speaking with community partners to effectively comprehend the difficulties that their respective community networks’ face. By placing special attention to the difficulties and fears that have surfaced, these champions are able bridge the information gap between society and bilateral/multilateral donors. For example, an advocacy organization known as “Motivation” – based in India and other African countries – have reached out to more than 400 disabled people so far, assessing their immediate and longer-term needs. Moreover, NGOs also put their knowledge on dealing with pandemics by alleviating the health burden that individuals have during periods of uncertainty. Specifically, they can join forces with clinics and health centers to give sanitation supplies and hygiene kits.

NGOs leverage upon the power of partnerships and use it as a tool to reassess their programmatic areas of focus. During the crisis, several NGOs have made a conscientious effort to strengthen WASH programs/services and support behavior change. Specifically, organizations that are equipped with the necessary liquid capital are supporting local in-country efforts to counteract the rippling social effects of the virus. For example, Action Against Hunger is working with the Ministry of Health in Somalia to ensure vital information on preventative measures, such as hand washing (considering the fact that the virus spreads faster from hand contact with the eyes, nose and mouth) is reaching vulnerable communities. For example, Tear fund and World Vision are applying the lessons learned from the Ebola crisis. They are working together with local advocates to communicate health messages using radio spots. Water Aid and Oxfam are also scaling up their programs in water, sanitation and hygiene (WASH) with their partners. This includes increasing access to hand washing stations and soap, and delivering awareness-raising campaigns to curtail the virus’s spread. Considering the fact that the novel coronavirus survives and thrives on human hands, introducing hand washing measures to densely populated areas is of the essence. Another undeniably important role of NGOs during the COVID-19 pandemic is putting measures in place that are aimed at initiating and sustaining behavior change. Positive health behavior practices like regular hand washing and social distancing are being disseminated by NGOs to their consistencies. These practices lead directly educating and informing them and providing hand washing/sanitizing amenities.

The importance of humanitarian agencies/NGOs, is undoubtedly essential as seen in this research article. NGOs play important roles in mitigating the effects of the COVID-19 pandemic. Various measures have been and are still being applied by these humanitarian agencies in an attempt to return activities to normalcy. Past pandemics such as the Ebola and Zika viruses have served as eye openers in the development of a modus operandi in dealing with pandemics/crises. Summarily, NGOs are known to help hold communities together during infectious disease outbreaks. By efficiently alleviating panic, confusion and misinformation, they help the people that they serve make sense out of a pandemic situation while still working to increase their livelihood and chances of survival. They initiate and encourage much needed behavior changes which are pivotal to mitigating the further spread of infections during an outbreak. In addition, as knowledge organizations, NGOs advocate for and carry out public health research to build up on important health data. These go a long way in helping experts analyze and evaluate any threat that has been reported but also to determine what kind of response would work best in addressing an infectious disease outbreak.

Insights from the COVID-19 pandemic in Africa

The COVID-19 pandemic is continually spreading through various countries in different continents with no vaccine at the moment. Africa is not as hard hit as other continents due to reasons such as low test levels, experience from past pandemics, climate, isolation measures and movement restrictions. This research gives a deeper in-sight into understanding these reasons and lessons for futuristic purposes. Amid the COVID-19 pandemic, testing rates in Africa are quite low when compared to other parts of the world – this is due to the lack of resources and funding to purchase enough testing kits and also the inability to manufacture them. There is a general consensus among those in charge of health policy on the continent that testing rates are woefully low, and this could be distorting our understanding of how far the virus has spread. The low number of COVID-19 victims can be attributed to the half-done testing processes carried out. The World Health Organization says “most” of the 37 countries in Africa with testing capacity have between 100 and 200 testing kits. In order to be certain of the true extent to which the virus has spread in Africa, an increase in testing needs to be introduced and implemented by various governments in the continent so as to ascertain the accurate rates of the spread. Increasing testing rates would also help identify asymptomatic patients who are spreading this virus unconsciously. The inability of agencies tasked with carrying out the tests in African countries to actually test as many individuals as possible, results in the disparities in confirmed cases in the continent. Without proper equipment for extensive testing, there might be several deaths that go unnoticed or unrecorded. For example, South Africa— which has the most advanced healthcare system in sub-Saharan Africa—has so far only managed to test around 73,000 of its 57 million inhabitants. Nigeria, Africa’s biggest economy, has only carried out 5,000 coronavirus tests to date for a country of 190 million people. Therefore, extensive testing plays a critical role in determining the incidence rate of the virus in Africa.

Conclusion

Collective action and effective global health governance are proven innovative ways for mitigating the effects of COVID-19. Moreover, they can be a panacea for the daily needs of individuals and their communities. In order to effectively harness these frameworks, it is critical that social networks are highly interactive and information flows in open systems. Fluid and effective collaboration between NGOs and governments need to be established as it can foster timely and accurate information/ knowledge sharing as well as efficient use of resources. Nevertheless, actions that undermine evidence-based science must be counteracted by an increase in public awareness and a more active civil society presence. As nations go further in the pandemic, applying the lessons learned in fighting previous pandemics is critical. These lessons cannot be generalized but must be customized to fit the context of the locale.

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