How must the global health and AIDS architecture be modernized to achieve

sustainable global health?

University College London2 December 2013

Preliminary Findings

• Underlying political economy of incentives– Drivers of funding engagement at global level– Post-ODA focus & nature of public-private engagement

• Concrete focus on options– Acquisitions, mergers and abolition (equivalent internal logics)– Integration & fragmentation/plurality (at top and bottom)

• Need for clear-eyed reflection on UNAIDS by WGs– Dig down on examples of success and failure & counter-factual

• Activist fatigue and accountability deficits– Pathways of change & alliance structures– Can architecture capture the ‘spirit’ of the movement

Taking Stock: Opportunities and Lessons Learnt from the AIDS Response for Global Health Governance

• Assumption of equivalence: AIDS & global health– Disease targets and/or– Social determinants of health

• Principles: justice, human rights, equity and rule of law– Framework Convention on Global Health

• Building scenarios – MDG versus SDG lens1. Market mechanism (‘survival of the fittest’)

2. UN as legitimate focal point (global public goods)

3. Consolidation around country-level (e.g. IHP)

4. Form follows function (SDG: goal-oriented)

• How scenarios affect current decision-making (finance)

Modernising the global heath and AIDS architecture: Law, Institutions, and Public-Private Authority

• Caution in seeking out ‘low-hanging fruit’• Responsive architecture

– Incentives & distributional consequences (winners & losers)

• Recipient-led and/or donor-led reform– LIC (financing) and MIC (data-demand/what works?)

• The BRICS

– Exercising different forms of power (hard versus soft)

• Reporting and soft law approach– Arbitration body

• Enhance accountability system (beyond reporting) – Independent accountability arrangement

Pathways to enhancing coherence of the global health architecture