| Summary: | “Governance” is the management of events in a social system. “Good governance” in global health requires institutions capable of effectively delivering health goods, and mechanisms of participation and accountability that maximize the extent to which stakeholders at all levels can shape both the ends and the means of health programs. The OSI Seminar on the Global Governance of Health brought together 40 global thinkers and leaders in public health, health services delivery, health policy, and academia for two days of intensive discussion of the current state of health governance, followed by two days of collaborative brainstorming on new initiatives in governance practice, research and theory. Over the course of the Seminar, this group of prominent practitioners and theoreticians agreed that governance was important, timely, and unduly neglected in health. Ranging in scope from the city to global levels, presentations and comments laid out a complex picture of how governance deficiencies limit the impact of efforts to promote a higher level and fairer distribution of good health around the world. There was wide agreement that most of the pivotal issuesincluding inefficient resource allocation, corruption, top-down program design, lack of coordination, and insufficient involvement of civil societycould profitably be conceptualized as failures of governance. Despite this agreement, attendees had much difficulty arriving at a consensus on what terms or indicators to use to conceptualize these governance failures and what efforts are needed to remedy them. This struggle paved the way to constructive ideas about the necessary next steps for an initiative to improve the global governance of health. Five themes emerged from these proceedings: - This is a time of opportunity for meaningful change in the governance of global health programs. - The governance of health at the global level is weak and coordination is poor. - Participatory rhetoric from powerful actors has fallen short of giving stakeholders and civil society a meaningful role in decision-making. - Despite the rise in funding and interest in disease-specific programs, the core mission of promoting population health and improving health systems is being obscured. - Major empirical and political work is needed to improve the governance of global health programs. Participants suggested a comprehensive, well-coordinated program of action in which health leaders, practitioners, researchers and civil society stakeholders would: 1. Design and implement strategies to mobilize global health leaders to improve governance internallyin their own organizationsas well as the system on the whole; 2. Develop strategies and build coalitions for boosting support among global elites for stronger public health institutions and global governance architecture built on a properly funded “anchor” institution; 3. Provide functional mechanisms of representation and organization of civil society in global health architecture, including support for civil society at the local level to participate effectively, continued human rights advocacy, and re-thinking current frameworks (such as the Global Fund’s CCM) from a governance standpoint. 4. Conduct interdisciplinary research to advance systematic measurement of governance, and identify or develop models of good health governance at the local, national and international levels.
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