The Global Health Governance Coronavirus Appeal: Building the Reset

This a global appeal. It is a worldwide open invitation to contribute to the global governance ‘reset’ which will have to follow the current COVID-19 emergency response phase. This is a matter of urgency. The challenges to our health and social systems and the inequities of our economic world order have once again become clear for everybody to see. After the current phase of ‘response’, the world will have to give shape to ‘recovery’ and ‘reset’, locally, nationally, regionally and worldwide. Importantly, the choices we make today will impact on the spaces available for necessary transformations tomorrow. So, we have to be on high alert. The preparations for recovery and reset will have to start now. Actionably. We think the rich experiences of many health systems governance communities and networks, currently all busy organizing their thoughts and contributions in the face of the current catastrophe, can and should be brought to bear. Hence this proposition to align and focus our collective efforts and with all our energy assemble the concrete building blocks for the future.           

Given the urgency of the matter, this appeal is kickstarted by a few networks this week: the Health Systems Governance Collaborative, together with UHC2030, The Collectivity, and the Covid/Coronavirus Ethics group. Health Systems Global will share the appeal with its members. Of course, anybody else is welcome to join. Our chief purpose is to help boost and enhance, not replace the great efforts that are currently ongoing in many places! We feel it is currently of the essence to connect the many dots and build pathways of change together. Now is the time.

All workstreams and contributions can be found on the dedicated interactive space

I. THE CORONAVIRUS MOMENT

The world is in the grip of CoVID-19. Many say that ever since the Second World War, we have not seen a moment in which so many people have been engaged around one topic, all at once. Understandably, the emergency discussions still dominate the news: about prevention of the spread of the virus, the divergent degrees of preparedness for dealing with people who fall seriously ill, or the emergency measures taken to support our economies. The enormous human costs in terms of loss or fundamental disruption of lives and livelihoods make themselves felt in many people’s homes. Huge simultaneous mobilizations take place on several fronts: political, scientific, financial. Far-reaching appeals are being made to citizens: to distance themselves from each other, to stay at home, to avoid gatherings, to close their shops and businesses, to take losses with no clear end date in sight. Previously hard-to-achieve decisions all of a sudden seem possible: many previously deadlocked discussions now turn fluid under the pressure. All this unfolds in an environment where people are learning while running, where scientific insights are evolving under our eyes and where an avalanche of ‘latest news’ (not always nuanced or well digested) is relentlessly being thrown at already anxious people. Armies of self-appointed experts add to the deliberation, and also to the confusion.

This ‘coronavirus moment’ exposes our world and our world-wide human relations for what they are. It opens up the full dynamic complexity of human existence on planet earth. It underscores our fragility, fundamental Angst, our (lack of) resilience. It highlights our inequities, the injustices we may have actively ignored or been indifferent to for decades. It puts the spotlight on the inadequacies and flaws in our health and social systems, the blind spots of our economic order. There is no hiding from this now.

At the same time, this moment also foregrounds our collective ingenuity and knowledge, our creativity, the many acts of solidarity. It opens vistas of creativity. And it produces millions of signs that people do wish to contribute to something better, not to waste this crisis, and have something better emerge.

II. THE GLOBAL HEALTH GOVERNANCE CORONAVIRUS APPEAL: COLLECTIVE ACTION TO BUILD THE RESET

In this whirlwind coronavirus context, we position this concrete global governance appeal. We reach out to all our health systems governance community participants and sympathizers to consider getting involved in starting to assemble insights and building blocks for the crucial health and social systems reset which will necessarily need to take place after the coronavirus emergency phase. We ask everybody to team up in this effort as much as possible. And we will link this effort with related networks in health and governance. We open the HSG Collaborative platform for this collective action and will put extra effort in to grow constructive efforts to the future.

We fully appreciate that people are currently differently occupied. We thus ask people to partake from wherever they are, by whatever means they currently can.  

IIA. Drawing on our health systems governance community: different positions

The health systems governance community around the world is made up of very different constituencies: policy makers, health and governance practitioners, civic organizations and community activists, and a wide range of academics. We appeal to them first, but of course, this is an open exercise inviting all concerned to engage if they wish.

• Some of us are in the frontlines of the current coronavirus 'emergency'. These persons are fully occupied with the emergency-measures. If in the process they find time to share observations now, that is excellent, if later: great. We will try to assess what governance ‘needs’ emerge from their corners.

• Some of us are close to the frontlines (back-up health workers, wider circle of health policy persons, civic and community organizations, policy advisors) but with more time to reflect. Those people could help assemble, survey, study one or more of the multifarious dimensions of this crisis now coming to the fore. According to each person's individual interest people could contribute to gathering and ordering information, make overviews, collect data, share reflections on the challenges of that, and contribute to acute observations regarding knowledge sharing and management.

• Some of our participants are researchers, civil servants, and other health people not directly in the frontlines but with a keen interest in the processes of longue durée, and a clear eye for structural issues and policy / governance needs. Those people could engage in more in-depth research activities, analyses and reflections.

Our sense is that all have important insights to contribute. Together we could build a ‘reset’: narratives, conceptualizations, practices and propose concrete roads. In this first stage, with the pressures of the ‘emergency’ all around us, it is important we share and try to align where we can. This is why we propose to focus on a number of key topic areas (not denying the importance of many others).

II.B Seven key areas of deliberation and collective action – Seven streams to grow

The range of possible reflections on how to move forward towards a progressive ‘reset’ of our health and health systems governance is very broad. New governance perspectives already occur in the acute phase, with people identifying governance functions and institutions that enable the response and governance bottlenecks that hinder it.

This global appeal is focused on contributing to ‘building the reset’. To kickstart our initiative, we propose seven key areas, subject areas that have emerged in conversations with many people. They are on purpose fairly broad domains of reflection, to allow diverse contributions to be shared and growing ‘the streams’. In the course of the coming weeks and months, we hope that together we can focus more and more, to feed into building the reset. We will organize webinars to support that process of deepening and strengthening the collective efforts.

1. From mere efficiency to dynamic adaptive systems, rethinking our health systems In this stream we will highlight and reference work dealing with building a shift from a dominant health systems ‘efficiency’ paradigm to complex, dynamic, adaptive systems. If anything emerges as painful awareness from this crisis, it is the hampered levels of adaptivity of many health care systems, even (or maybe notably) in the richer parts of the world. For decades, an ‘efficiency’ paradigm has reigned at the detriment of more investment in ‘(local) contextuality’, ‘flexibility’, ‘adaptivity’. We need to rethink urgently how health systems around the world could be reconfigured as dynamic adaptive systems. Even in this emergency phase, this is already on top of the agenda in most countries, now we see that systems cannot handle ‘surges’. But also beyond the immediate demands, suggestions of adaptation/adaptivity have emerged in many settings for a while, and not should be taken to the next level.
2. Health as common good In this stream, we will put the spotlight on work going on regarding the shift towards ‘health as common good’, health as fundamental underpinning for productive societies, and health as a crucial part of the sustainable development agenda. It has now become clear to anybody still in doubt that health and healthcare should not be viewed as mere social ‘expenditure’ or a drain on public resources, but rather as a necessary common good contributing to the social wellbeing and economic sanity of the world, and as a vital area of social investment. This is not a new message, but the ‘how’ of starting from this Step Zero of future health systems efforts needs to be revisited as a matter of urgency.
3. Upgrading the health and equity agendas, and deeper awareness of cultural dimensions of health, reimagining public health This stream will contain the growing number of current reflections which signal how the CoVID-19 outbreak regimes (notably with respect to the tough lockdowns) have foregrounded the huge inequities in health and governance systems. Here we will cite articles or blogs which have cautioned against any simple ‘copy-pasting’ of measures, keeping in mind the human rights dimensions and the widely varying economic consequences of globalizing ‘health regimes’.  Beyond this, reimagining public health has become a strong obligation. It is vital to study in detail the various scenarios for post-coronavirus equity upgrades and showcase ongoing work on actionable propositions for new public health arrangements.
4. Building new agency in governance, shifting powers in health and health systems This stream will foreground how under the pressures of the CoVID-19 outbreak, issues around health ‘agency’ and ‘leadership’ have gained new importance. A range of deeper governance problems related to political regimes, democratic and human rights challenges, and levels of civic agency are now again out in the open. It is vital not to lose track of decentralization agendas and further community engagement in governance. Now is the time to reflect on a fundamental rebalancing of powers and responsibilities to deal with health challenges in the future.
5. Planetary health: the next frontier This stream will reference all contributions which deal with how to move governance focus to climate change, biodiversity and planetary health fundamentals.
6. New multilateralism in health This stream will revisit the global health architecture. After decades of international development efforts, the CoVID-19 outbreak has demonstrated the advantages but also the deep and acute flaws of the current global health architecture and the powers/powerlessness embedded in that system. On the basis of all we can observe now, this architecture will have to be fundamentally revisited. We should start to think how that process could take place in a broad and much more inclusive global interaction. We also need to reconsider the relationships between states in this respect.
7. Cross-cutting: pathways of change and preventing ‘crisis grab  With this appeal, we wish to draw attention to work focused on actionable propositions for governance reset. Beyond the thematic inputs 1-6, this stream will support the cross-cutting work, focused on feasible pathways of change. Under this heading we would welcome links or blogs around questions such as a) how to engage nations, institutions, agencies in new ways; b) what are pathways to constructive power can be imagined; c) which roles could be played by vocal critiques and influential voices, in media or elsewhere; d) which ‘grabbing of the crisis’ should be critically followed and in some cases resisted. We urgently need to protect the spaces for such reflections to actually happen. For this crisis should not be captured by the forces of status-quo or regression.

III. HOW YOU CAN ENGAGE

Just sharing

If you or your network have content you wish to share in the context of this Global Appeal use the “contact us” button on the Collaborative website, or write us directly: governance.collab@gmail.com

• Present already published material in the form of three lines of headlines of your article/blog plus a weblink (plus contact details - optional). Select the ‘stream’ to which you wish to contribute.
• Present new blogs in the form of a simple Word document, also with three lines of introduction explaining the main points of the blog (plus contact details optional). Select the stream to which you wish to contribute.
• Present video and film only through web links! Select the stream.

Seeking further dialogue and connection

If you wish to engage more deeply and deliberate with others, use the chat and comment functions of the Collaborative website and connect with authors and other Collaborative members. For this, you would have to create your own Collaborative account. It is a simple procedure, using the sign-up button, or https://hsgovcollab.org/en/user/sign-up

Newsletter Reset Building Blocks

The Collaborative small support group of this Global Appeal will issue a weekly Building Blocks newsletter which will be sent to networks and anybody interested.

Webinars

To support the building of the seven streams, we will start to set up monthly Building the Reset webinars, together with the networks involved.

Networks

Given the vital urgency of this appeal, we kickstart this initiative on April 16, with the active engagement of the HSGC, The Collectivity, UHC2030, Coronavirus/Covid Ethics. HSG will share the appeal with their members and working groups. We will reach out to a wide range of other friendly networks around the world. If you wish to join the Reset Appeal and have your work featured in this context, please write an email to governance.collab@gmail.com

Remember

Our initiative is to boost sharing, connect dots, build vital streams. All contents will be open access.

WE ARE NOT MERE VICTIMS OF DISASTER. WE ARE ACTIVE BUILDERS OF OUR COLLECTIVE FUTURES. THE TIME TO RETHINK AND JOIN FORCES IS NOW!