Who are the power brokers in global health and what is the impact of their control and dominance over, for example, the World Health Organization, World Bank, Gavi and Global Fund? What reforms are needed to democratise global health governance and give greater voice to marginalised perspectives?

Global Health may also be conceived of as a ‘landscape’ – made of decision-making spaces, governance structures, norms and systems – that may itself be ‘colonised’ in the sense of being dominated by powerful actors to the detriment of less powerful actors and populations.

The structures and systems of Global Health governance have long been shaped by the interests and agendas of more powerful countries, as well as of powerful private actors. For more than two decades, the People’s Health Movement (a civil society network mostly rooted in the Global South) and others have worked hard to ensure that the World Health Organization is funded, governed and managed in a way that is equitable and in keeping with its constitutional mandate. However, WHO has a history of being hindered by international geo-politics and corporate lobbying, and dominated by certain actors and ideologies. See here and here. 

The transformation of the Global Health landscape over the last three decades with the entry of the World Bank, emergence of multiple public-private partnerships, growth of powerful international NGOs and the ascendancy of the Bill and Melinda Gates Foundation (possibly the most powerful single Global Health actor) has also resulted in major shifts of power across the global health system in ways that may have weakened democratic accountability and aggravated inequalities.