Social Europe

politics, economy and employment & labour

  • Themes
    • Global cities
    • Strategic autonomy
    • War in Ukraine
    • European digital sphere
    • Recovery and resilience
  • Publications
    • Books
    • Dossiers
    • Occasional Papers
    • Research Essays
    • Brexit Paper Series
  • Podcast
  • Videos
  • Newsletter
  • Membership

Global health governance from the grassroots

Ngaire Woods and Ok Pannenborg 2nd June 2021

To be better prepared for future pandemics, global agreements must shape responses grounded firmly in local communities.

grassroots,communities,bottom-up
Ngaire Woods

The World Health Assembly met last week amid a slew of proposals—most recently from the United Nations Independent Panel for Pandemic Preparedness and Response—to create stronger, enforceable global rules for tackling future infectious disease outbreaks. A new global pandemic treaty, more robust and independent international institutions and an international pandemic financing facility are all in the mix. But a bottom-up strategy might work better.

A separate review by the World Health Organization earlier this year highlighted four ways to strengthen global health governance. It called for a centralised approach to bolstering countries’ preparedness for health emergencies; a worldwide notification system to ensure robust monitoring of compliance; global capacities such as a genomic sequencing infrastructure, and closer co-ordination among international institutions, including the WHO, the World Organisation for Animal Health, the Food and Agriculture Organization and the United Nations Environment Programme.

grassroots,communities,bottom-up
OK Pannenborg

These are all worthy objectives. But is a top-down approach the best way to pursue them? To answer that question, global health experts should pay more attention to successful grassroots efforts to combat disease.

Bottom-up strategy

Consider the fight against onchocerciasis, or river blindness. In the 1970s, it was led by the World Bank president, Robert McNamara, the Merck chief executive officer, Roy Vagelos, and the WHO director-general, Halfdan Mahler. But, over time, a bottom-up strategy, whereby almost half a million village community-health workers owned the problem, proved more effective. A 1994-95 multi-country study showed that when communities are responsible for organising their own distribution of ivermectin (the drug that treats onchocerciasis), coverage is higher than when the health system delivers the drug. Another report by the Carter Center highlights the role that kinship and local networks play in tackling this disease.


Become part of our Community of Thought Leaders


Get fresh perspectives delivered straight to your inbox. Sign up for our newsletter to receive thought-provoking opinion articles and expert analysis on the most pressing political, economic and social issues of our time. Join our community of engaged readers and be a part of the conversation.

Sign up here

Similarly, the Bombay Leprosy Project is a longstanding program in Mumbai’s largest slums, such as Dharavi. BLP community volunteers, trained by paramedical workers, conduct door-to-door surveys among the population to detect new cases. During the pandemic, it has been one of the most effective channels for delivering personal protective equipment (PPE), health care, food and now Covid-19 vaccinations to the poorest of the poor, in areas where the Maharashtra state and federal governments are essentially absent.

The importance of bottom-up initiatives in responding to the pandemic is not limited to developing countries. The United Kingdom’s government invested heavily in a centralised, national test-and-trace service. But evidence suggests that even relatively underfunded local schemes performed better, leading the government to rethink its approach.

Receptive audience

Increased efficacy is not the only reason to consider a grassroots strategy. Politically, many countries—perhaps scarred by their experience of trade blockages at the outset of the pandemic, the worldwide scramble for PPE supplies and vaccine nationalism—are currently more focused on national resilience than global commitments. A new emphasis on local resilience may therefore find a much more receptive audience in communities around the world. One of the shortcomings of international health regulations during the Covid-19 pandemic has been the failure to prepare, provide and co-ordinate adequate resources at the country level. A bottom-up approach could change this.

Moreover, investments in community-level health-surveillance capacity will likely be key to tackling this and future pandemics. Here, the right financial incentives are crucial. Rural smallholders in Africa and Asia will be the first to know when some of their chickens or ducks seem sick—possibly with an avian influenza virus that could trigger a human pandemic. But if farmers who report a disease outbreak face the prospect of culling their entire flock without receiving adequate compensation, they may well decide not to share the information.

Likewise, as Stefan Dercon of the University of Oxford has argued, investing in the reach and quality of community healthcare and in health workers’ protection is vital to ensure the continuation of basic medical services. These include vaccination, provision of antiretrovirals, supplementary feeding, maternal health, bed-net distribution and malaria treatment. Community health workers are also essential for shielding the most vulnerable in densely populated areas, and for tracking and controlling disease.

Such bottom-up approaches will require government support, including financing of local efforts. Any backing may need to be anchored in law to be sustainable, as was the case with the funding of Brazil’s public-health research institution Fiocruz in the early 20th century. Such statutes may protect organisations from attempts to reduce budget allocations or finance other programmes at their expense.

Heightened awareness

Historically, global health and environmental co-operation has reflected various combinations of top-down and bottom-up measures. While the 1987 Montreal protocol to protect the ozone layer was an example of top-down regulation, the 2015 Paris climate agreement resulted from a much longer process involving communities, cities and countries around the world. Academic studies and research by hundreds of universities, institutes and scientists, and early initiatives by mayors and individual communities, greatly heightened grassroots awareness and commitments from families, schools, local media, municipalities and regional administrators.

In the end, even the best bottom-up disease-control efforts risk being thwarted by international failures to ensure access to PPE, genetic sequencing or vaccines. But policy-makers must not neglect local-level health care. To be better prepared for future pandemics, our top-down models and agreements must shape responses that are grounded firmly in local communities and value their engagement, risk ownership and anxieties.


Support Progressive Ideas: Become a Social Europe Member!


Support independent publishing and progressive ideas by becoming a Social Europe member for less than 5 Euro per month. You can help us create more high-quality articles, podcasts and videos that challenge conventional thinking and foster a more informed and democratic society. Join us in our mission - your support makes all the difference!

Become a Social Europe Member

Republication forbidden—copyright Project Syndicate 2021, ‘Global health governance from the grassroots’

post-Brexit
Ngaire Woods

Ngaire Woods is dean of the Blavatnik School of Government at the University of Oxford.

Ok Pannenborg
You are here: Home / Politics / Global health governance from the grassroots

Most Popular Posts

Belarus,Lithuania A tale of two countries: Belarus and LithuaniaThorvaldur Gylfason and Eduard Hochreiter
dissent,social critique,identity,politics,gender Delegitimising social critique and dissent on the leftEszter Kováts
retirement,Finland,ageing,pension,reform Late retirement: possible for many, not for allKati Kuitto
Credit Suisse,CS,UBS,regulation The failure of Credit Suisse—not just a one-offPeter Bofinger
Europe,transition,climate For a just and democratic climate transitionJulia Cagé, Lucas Chancel, Anne-Laure Delatte and 8 more

Most Recent Posts

Barcelona,feminist,feminism Barcelona: a feminist municipalism now at riskLaura Pérez Castaño
Spain,elections,Sánchez Is Spain on the right track?Bettina Luise Rürup
CBI,Confederation of British Industry,harassment Crisis at Britain’s CBI holds lessons for othersMarianna Fotaki
central and eastern Europe,CEE,renewable Central and eastern Europe: a renewable-energy win-winPaweł Czyżak
Cape Town,inequality Tackling inequality in the city—Cape TownWarren Smit

Other Social Europe Publications

Bildschirmfoto 2023 05 08 um 21.36.25 scaled 1 RE No. 13: Failed Market Approaches to Long-Term Care
front cover Towards a social-democratic century?
Cover e1655225066994 National recovery and resilience plans
Untitled design The transatlantic relationship
Women Corona e1631700896969 500 Women and the coronavirus crisis

Hans Böckler Stiftung Advertisement

The macroeconomic effects of re-applying the EU fiscal rules

Against the background of the European Commission's reform plans for the Stability and Growth Pact (SGP), this policy brief uses the macroeconometric multi-country model NiGEM to simulate the macroeconomic implications of the most relevant reform options from 2024 onwards. Next to a return to the existing and unreformed rules, the most prominent options include an expenditure rule linked to a debt anchor.

Our results for the euro area and its four biggest economies—France, Italy, Germany and Spain—indicate that returning to the rules of the SGP would lead to severe cuts in public spending, particularly if the SGP rules were interpreted as in the past. A more flexible interpretation would only somewhat ease the fiscal-adjustment burden. An expenditure rule along the lines of the European Fiscal Board would, however, not necessarily alleviate that burden in and of itself.

Our simulations show great care must be taken to specify the expenditure rule, such that fiscal consolidation is achieved in a growth-friendly way. Raising the debt ceiling to 90 per cent of gross domestic product and applying less demanding fiscal adjustments, as proposed by the IMK, would go a long way.


DOWNLOAD HERE

ETUI advertisement

The four transitions and the missing one

Europe is at a crossroads, painfully navigating four transitions (green, digital, economic and geopolitical) at once but missing the transformative and ambitious social transition it needs. In other words, if the EU is to withstand the storm, we do not have the luxury of abstaining from reflecting on its social foundations, of which intermittent democratic discontent is only one expression. It is against this background that the ETUI/ETUC publishes its annual flagship publication Benchmarking Working Europe 2023, with the support of more than 70 graphs and a special contribution from two guest editors, Professors Kalypso Nikolaidïs and Albena Azmanova.


DOWNLOAD HERE

Eurofound advertisement

Unaffordable and inadequate housing in Europe

Unaffordable housing is a matter of great concern in the European Union. It leads to homelessness, housing insecurity, financial strain and inadequate housing. It also prevents young people from leaving their family home. These problems affect people’s health and wellbeing, embody unequal living conditions and opportunities, and result in healthcare costs, reduced productivity and environmental damage.

This new report maps housing problems in the EU and the policies that address them, drawing on Eurofound’s Living, working and Covid-19 e-survey, EU Statistics on Income and Living Conditions and input from the Network of Eurofound Correspondents.


DOWNLOAD HERE

Foundation for European Progressive Studies Advertisement

The spring issue of the Progressive Post magazine from FEPS is out!

The Special Coverage of this new edition is dedicated to Feminist Foreign Policy, to try to gauge its potential but also the risk that it could be perceived as another attempt by the west to impose its vision on the global south.

In this issue, we also look at the human cost of the war in Ukraine, analyse the increasing connection between the centre right and the far right, and explore the difficulties, particularly for women, of finding a good work-life balance and living good working lives.


DOWNLOAD HERE

About Social Europe

Our Mission

Article Submission

Membership

Advertisements

Legal Disclosure

Privacy Policy

Copyright

Social Europe ISSN 2628-7641

Social Europe Archives

Search Social Europe

Themes Archive

Politics Archive

Economy Archive

Society Archive

Ecology Archive

Follow us

RSS Feed

Follow us on Facebook

Follow us on Twitter

Follow us on LinkedIn

Follow us on YouTube