Making Space for Qualitative Evidence in Global Maternal and Child Health Policymaking

The success of health interventions often hinges on complex processes of implementation, the impact of sociopolitical and cultural contexts, resource constraints and opportunity costs, and issues of equity and accountability. Qualitative research offers critical insights for understanding these issues. “Qualitative evidence syntheses” (or QES)—modeled on quantitative systematic reviews—have recently emerged as an important vehicle for integrating insights from qualitative evidence into global health policy. However, it is challenging to integrate QES into policymaking in ways that are both acceptable to the often-conservative health policy world and consonant with social science’s distinctive methodologies and paradigms. Based on my experiences participating in and observing numerous guideline working group meetings and interviews with key informants, this chapter offers an auto-ethnographic account of an effort to integrate QES into the World Health Organization’s global OptimizeMNH guidelines for task shifting in maternal and newborn health (MNH). It is based on my experiences participating in and observing numerous guideline working group meetings as well as interviews with several key informants. Advocates of QES were successful in helping to make a place for qualitative evidence in this global guideline. Their work, however, required a delicate balance between adopting quantitatively inspired methods for evidence synthesis and innovating new methods that would both suit the project needs and be seen as legitimate by qualitative researchers. This case study of the development of one WHO guideline does not signal a revolution in knowledge production, but it does show there remains room—perhaps growing room—for a more expansive vision of what forms of knowledge need to be on the table when developing global health policy.

The Challenge of Vaccine Nationalism

The COVID-19 pandemic has had a devastating impact on global health for almost two years, resulting in nearly 200 million cases and over 4 million deaths worldwide. Despite a range of non-invasive public health measures, (i.e. physical distancing, and masks) vaccines have been one of the more critical and effective interventions to slow the pandemic. Produced at record-breaking speeds, the highly efficacious mRNA vaccines represented hope for many. Including global health organizations who have called for strategies to maximize vaccine equity since their conception. While many high-income countries (HICs) agreed to prioritize global vaccine equity; in truth, individual health outweighed community health. The reality of HICs vaccine purchasing behaviors and distribution have exposed a different agenda - one that aligns with a neoliberal emphasis on individuals and profits at the expense of global good. This commentary questions the efficacy of global health agreements and the commitment from wealthy countries to address global health inequities through a one health framework. Ultimately, concluding that the path to global vaccine equity will require a commitment to global good. Vaccine nationalism and lack of equitable global health policy continues to fuel a never-ending health crisis. HICs must be held accountable for the lack of commitment to global health equity.

Refugee Mental Health, Global Health Policy, and the Syrian Crisis

The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced and 26.4 million registered refugees. The ongoing conflict in Syria is a major contributor. After a decade of violence and destabilization, over 13.4 million Syrians have been displaced, including 6.7 million internally displaced persons and 6.7 million refugees registered in other countries. Beyond the immediate political and economic challenges, an essential component of any response to this humanitarian crisis must be health-related, including policies and interventions specific to mental health. This policy and practice review addresses refugee mental health in the context of the Syrian crisis, providing an update and overview of the current situation while exploring new initiatives in mental health research and global health policy that can help strengthen and expand services. Relevant global health policy frameworks are first briefly introduced, followed by a short summary of recent research on refugee mental health. We then provide an update on the current status of research, service provision, and health policy in the leading destinations for Syrians who have been forcibly displaced. This starts within Syria and then turns to Turkey, Lebanon, Jordan, and Germany. Finally, several general recommendations are discussed, including the pressing need for more data at each phase of migration, the expansion of integrated mental health services, and the explicit inclusion and prioritization of refugee mental health in national and global health policy.

Feminist Global Health Security

Feminist Global Health Security highlights the ways in which women are disadvantaged by global health security policy, through engagement with feminist concepts of visibility; social and stratified reproduction; intersectionality; and structural violence. The book argues that an approach focused on short-term response efforts to health emergencies fails to consider the differential impacts of outbreaks on women. This feminist critique focuses on the policy response to the Zika outbreak, which centred on limiting the spread of the vector through civic participation and asking women to defer pregnancy, actions that are inherently gendered and reveal a distinct lack of consideration of the everyday lives of women. The book argues that because global health security lacks a substantive feminist engagement, policies created to manage an outbreak of disease focus on protecting economies and state security and disproportionately fail to protect women. This state-based structure of global health security provides the fault-line for global health security and women. Women are both differentially infected and affected by epidemics and, the book argues: it was no coincidence that poor, black women living in low quality housing were most affected by the Zika outbreak. More broadly, it poses the question: What would global health policy look like if it were to take gender seriously, and how would this impact global disease control sustainability?

Accountability in the global health regime : a critical examination of the institutional policy and practice of the global fund to fight HIV/AIDS, tuberculosis and malaria partnership programme in Ghana

The overarching objective of this thesis is to undertake a critical examination of the institutional accountability policy and practice of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in the context of its partnership programme in Ghana. The Global Fund is a global public-private partnership (GPPP) in health engaged in public health policy processes worldwide. As a GPPP, the policy mandate that underpins its global response to fight the aforementioned diseases requires it to enter into partnerships with recipient countries to finance their national health policy responses and strategies to tackle these diseases. Situating accountability within the context of the shift from an international health to a global health regime, the study argues that the emergence of GPPPs in health and the formal policy mandate and decision-making powers they exercise have had knock-on consequences for understanding accountability in the global health regime. This is because while the understanding of accountability for public health policy processes in the international health regime revolved solely around state-based and state-led accountability processes, it is no longer so in current global health regime. Since these GPPPs are not states, they derive their understanding of accountability from the nature and character of their individual policy and practice arrangements. However, despite contestation around the Global Fund’s accountability in global health literature, this literature has little to say on the question of how the Global Fund itself (as a partnership organisation) understands accountability in policy and how this understanding informs its practice in specific settings of global health. Thus, this study contributes to literature on GPPPs’ accountability in global health by specifically exploring how the Global Fund understands accountability in policy and how this understanding informs its accountability in practice, in particular in relationship to its implications for country ownership of health policy in Ghana. Drawing on fieldwork undertaken in Ghana, and guided by a critical political economy approach, this study will demonstrate how: 1) the Global Fund’s institutional policy and practice arrangements undermine accountability to the government and to those affected by their activities; 2) the Global Fund’s practice of country ownership is reflective of conditional ownership despite the fact that the Global Fund claims to promote country ownership as a core principle of its accountability practice in aid recipient countries; and 3) the accountability policy and practice instruments of the Global Fund are not politically neutral, but are rather a function of relations of power. To improve the ability of Ghana (and other recipient countries) to own their developmental policies, a reordering of global economic relations is needed, with a renewed emphasis and focus on economic justice and human rights. Such a reordering will improve the material capabilities (control of and access to global centres of production, finance and technology) of aid recipient countries. This will empower Ghana (and other recipient countries) to play a more dominant, rather than a subsidiary role in how the global health landscape is organised and financed and in policy processes undertaken by global health policy institutions like the Global Fund. In this way, Ghana (and other developing countries) will be able to limit and mitigate the dominance and influence of powerful donors who shape the institutional policy and practice arrangements of global health policy institutions like the Global Fund.

Framing global discourses on non-communicable diseases: a scoping review

Background The choices that policymakers make are shaped by how their problems are framed. At last, non-communicable diseases (NCDs) have risen high on the global policy agenda, but there are many disputed issues. First, what are they? Their name refers not to what they are but what they are not. Second, where do their boundaries lie? What diseases are included? Third, should we view their causes as mainly biomedical, behavioural, or social, or a combination? Our failure to resolve these issues has been invoked as a reason for our limited progress in developing and implementing effective remedies. In this scoping review, we ask “What is known from the existing literature about how NCDs are framed in the global policy discourses?” We answer it by reviewing the frames employed in policy and academic discourses. Methods We searched nine electronic databases for articles published since inception to 31 May 2019. We also reviewed websites of eight international organisations to identify global NCDs policies. We extracted data and synthesised findings to identify key thematic frames. Results We included 36 articles and nine policy documents on global NCDs policies. We identified five discursive domains that have been used and where there are differing perspectives. These are: “Expanding the NCDs frame to include mental health and air pollution”; “NCDs and their determinants”; “A rights-based approach to NCDs”; “Approaches to achieving policy coherence in NCDs globally”; and “NCDs as part of Sustainable Socio-economic Development”. We further identified 12 frames within the five discursive domains. Conclusions This scoping review identifies issues that remain unresolved and points to a need for alignment of perspectives among global health policy actors, as well as synergies with those working on mental health, maternal health, and child health. The current COVID-19 pandemic warrants greater consideration of its impact on global NCDs policies. Future global strategies for NCDs need to consider explicitly how NCDs are framed in a changing global health discourse and ensure adequate alignment with implementation and global health issues. There is a need for global strategies to recognise the pertinent role of actors in shaping policy discourses.

Operationalizing the Ethical Review of Global Health Policy and Systems Research: A Proposed Checklist

There has been growing consensus to develop relevant guidance to improve the ethical review of global health policy and systems research (HPSR) and address the current absence of formal ethics guidance.