Inter-Institutional Relationships in Global Health: Regulating Coordination and Ensuring Accountability

摘要

The global health landscape is characterized by a multitude of actors, including nation states, international organizations and non-governmental organizations, all of which play substantial roles in addressing global health issues. The range of organizations involved means a substantial heterogeneity with respect to their structure, mandate, legal standing, and obligations. As well as this diversity, they are substantially differentiated with respect to the power, influence, and the financial resources they are able to mobilize in order to advance their organizational mission. This variety also continues further through to the ability to determine accountability, with each organization differing in the stakeholders to whom it is accountable; some may be accountable to shareholders or a Board of Directors, while others will be accountable to governing bodies, national parliaments, or to the member states which comprise the organization. As such, concepts of accountability are often limited to ensuring accountability for the success of the organizational leadership in achieving the goals related to the mission of the organization1. Thus, the fundamental motivations of organizations are broadly “self-regarding” in nature. This issue, and how this range of actors may be governed in a truly global constitutional system has been considered by a number of scholarly perspectives, resulting in robust, academic discussions on what the global constitutionalized system in global health ought to look like.2 However, one thing which has not yet been addressed fully in the literature, and which adds a distinct layer of complexity in current practice, without this fully formed constitutionalized system, is the fact that, when considering the relationships that organizations have with other relevant actors in the area; the extent to which enforceable obligations are owed between actors is unclear, and it is this which we focused on in the present paper. In this case we are not so much interested in beneficiaries of services provided by organizations, or services which have been formally contracted for between organizations, but rather, what sorts of obligations organizations have towards each other, beyond any contracted services.