Tuberculosis, childhood pneumonia, maternal death in childbirth, tobacco-related illnesses: how do global health networks select issues and seek to address these public health challenges that affect the world's poorest countries? How do these networks arise and garner resources? How adaptable are they to changing conditions, national governments, and shifting coalitions and interests? Why are some conditions targeted while others, equally widespread and serious, are not? And finally, are global networks useful at all?
For the past five years, an international team of 12 policy experts from North and South America and Europe, led by Jeremy Shiffman, professor at American University's School of Public Affairs, has been researching the impact and internal workings of global health networks across a wide spectrum of diseases and public health initiatives. Their often-surprising findings were released on April 26, 2016, in a special supplement of the journal Health Policy and Planning.
"Cross-national webs of individuals and organizations, global health networks have been pivotal in tackling some of the most pressing issues of the 21st century," says Shiffman. "This project is the first comparative effort to understand what makes them effective -- or ineffective, and whether they should have the kind of power to shape policy agendas that they do."
Composed of nine studies, the supplement offers insights on the emergence, effectiveness, and legitimacy of global health networks addressing newborn survival, maternal survival, pneumonia, tuberculosis, tobacco control, and alcohol abuse. The studies examine why some global health conditions and challenges attract greater policy attention and resources than others, despite comparable severity. According to Shiffman, global health networks do matter, particularly for shaping the way problems and solutions are understood, and for convincing governments, international organizations and other global actors to address the issue.
"This finding is not an obvious one," continues Shiffman. "The networks might have failed in their efforts. Or attention might have emerged entirely due to other factors, such as the individual rather than networked activity of involved actors, the influence of powerful nation-states or donors, growth in the severity of the problems and new solutions."
The research indicated that global health networks are most likely to produce effects when their members construct a compelling framing of the issue, one that includes a shared understanding of the problem, a consensus on solutions, and convincing reasons to act; and when they build a political coalition that includes individuals and organizations beyond their traditional base in the health sector. Coalition-building demands engagement in the politics of the issue, not just its technical aspects.
Shiffman and his colleagues found that the emergence and effectiveness of a network are shaped both by its members' decisions and by contextual factors, including historical influences (e.g. prior failed attempts to address the problem; features of the policy environment (e.g. global development goals); and characteristics of the issue the network addresses (e.g. its mortality burden).
One of the nine studies included in the supplement examines the Global Partnership to Stop TB. The study found that having a centralized core group and a strategic brand helped the network to coalesce around a primary intervention strategy, but that this centralization and stability has hindered its ability to adapt to new challenges in fighting the disease. Another paper discovered that global efforts to fight childhood pneumonia have lagged in part due to difficulties that members have had in agreeing on a shared identity to facilitate network coalescence. The authors also pointed out that a global network dedicated to advancing maternal health enjoyed considerable success after the issue became part of the United Nations' Millennium Development Goals.
The project was funded by the Bill & Melinda Gates Foundation and involved 12 investigators from European and North and South American institutions.
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