Paper short abstract:

Drawing from the focus of robust political economy on incentives and knowledge, we propose a framework for addressing emerging questions concerning the capacity of governance across multiple scales and policy sectors to coordinate the effective delivery of global health programmes.

Paper long abstract:

In the post-colonial era, while the governance of global health programmes has been opened up to community participation, the power and influence of supranational organisations is also increasing through organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Simultaneously, especially in conflict zones, or so-called failed states, the channelling of funds and programs through centralised bureaucracies in developing countries, a characteristic of the immediate post-colonial period, has come under greater scrutiny. Following high, documented levels of corruption and delays in fund disbursement, there is an increasing effort to avoid or bypass these risks and threats to successful program implementation at national scale by moving power and authority either to the supranational or local levels. Such strategies for ‘rescaling’ global health governance, while potentially improving programme delivery, particularly in emergency or outbreak situations, require careful consideration. Adopting a ‘robust political economy’ approach (Cowen 2016; Pennington 2017), we propose a framework for engaging more closely with this emerging research agenda concerning the capacity of governance institutions and arrangements in this changing context to promote global health, while also avoiding a supranational tendency towards forms of neo-colonialism. The dual focus of the approach upon both the incentives-related and epistemological dimensions of such coordination challenges for governance is demonstrated to be of pertinence for emerging questions about global health, such as building health system capacity to reduce long-term dependency on the assistance of former colonial powers. Exploring the epistemological dimension, it is argued, which involves considering the range of different locally situated forms of knowledge and expertise involved in health programme delivery, is of fundamental importance for governance evaluation, yet relatively neglected by established approaches.