importance of global health initiatives essay

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• Published: 07 April 2020

What is global health? Key concepts and clarification of misperceptions

Report of the 2019 GHRP editorial meeting

• Xinguang Chen 1 , 2 ,
• Hao Li 1 , 3 ,
• Don Eliseo Lucero-Prisno III 4 ,
• Abu S. Abdullah 5 , 6 ,
• Jiayan Huang 7 ,
• Charlotte Laurence 8 ,
• Xiaohui Liang 1 , 3 ,
• Zhenyu Ma 9 ,
• Zongfu Mao 1 , 3 ,
• Ran Ren 10 ,
• Shaolong Wu 11 ,
• Nan Wang 1 , 3 ,
• Peigang Wang 1 , 3 ,
• Tingting Wang 1 , 3 ,
• Hong Yan 3 &
• Yuliang Zou 3  

Global Health Research and Policy volume  5 , Article number:  14 ( 2020 ) Cite this article

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The call for “W orking Together to Build a Community of Shared Future for Mankind” requires us to improve people’s health across the globe, while global health development entails a satisfactory answer to a fundamental question: “What is global health?” To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word “global” in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of “international health” by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.

“Promoting Health For All” can be considered as the mission of global health for collective efforts to build “a Community of Shared Future for Mankind” first proposed by President Xi Jinping of China in 2013. The concept of global health continues to evolve along with the rapid development in global health research, education, policymaking, and practice. It has been promoted on various platforms for exchange, including conferences, workshops and academic journals. Within the Editorial Board of Global Health Research and Policy (GHRP), many members expressed their own points of view and often disagreed with each other with regard to the concept of global health. Substantial discrepancies in the definition of global health will not only affect the daily work of the Editorial Board of GHRP, but also impede the development of global health sciences.

To promote a better understanding of the term “ global health” , we convened a special session in the 2019 GHRP Editorial Board Meeting on the 7th of July at Wuhan University, China. The session started with a review of previous work on the concept of global health by researchers from different institutions across the globe, followed by free brainstorms, questions-answers and open discussion. Individual participants raised many questions and generously shared their thoughts and understanding of the term global health. The session was ended with a summary co-led by Dr. Xinguang Chen and Dr. Hao Li. Post-meeting efforts were thus organized to further synthesize the opinions and comments gathered during the meeting and post-meeting development through emails, telephone calls and in-person communications. With all these efforts together, concensus have been met on several key concepts and a number of confusions have been clarified regarding global health. In this editorial, we report the main results and conclusions.

A brief history

Our current understanding of the concept of global health is based on information in the literature in the past seven to eight decades. Global health as a scientific term first appeared in the literature in the 1940s [ 1 ]. It was subsequently used by the World Health Organization (WHO) as guidance and theoretical foundation [ 2 , 3 , 4 ]. Few scholars discussed the concept of global health until the 1990s, and the number of papers on this topic has risen rapidly in the subsequent decade [ 5 ] when global health was promoted under the Global Health Initiative - a global health plan signed by the U.S. President Barack Obama [ 6 ]. As a key part of the national strategy in economic globalization, security and international policies, global health in the United States has promoted collaborations across countries to deal with challenging medical and health issues through federal funding, development aids, capacity building, education, scientific research, policymaking and implementation.

Based on his experience working with Professor Zongfu Mao, the lead Editors-in-Chief, who established the Global Health Institute at Wuhan University in 2011 and launched the GHRP in 2016, Dr. Chen presented his own thoughts surrounding the definition of global health to the 2019 GHRP Editorial Board Meeting. Briefly, Dr. Chen defined global health with a three-dimensional perspective.

First, global health can be considered as a guiding principle, a branch of health sciences, and a specialized discipline within the broader arena of public health and medicine [ 5 ]. As many researchers posit, global health first serves as a guiding principle for people who would like to contribute to the health of all people across the globe [ 5 , 7 , 8 ].

Second, Dr. Chen’s conceptualization of global health is consistent with the opinions of many other scholars. Global health as a branch of sciences focuses primarily on the medical and health issues with global impact or can be effectively addressed through global solutions [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Therefore, the goal of global health science is to understand global medical and health issues and develop global solutions and implications [ 7 , 9 , 15 , 17 , 18 , 19 ].

Third, according to Dr. Chen, to develop global health as a branch of science in the fields of public health and medicine, a specialized discipline must be established, including educational institutions, research entities, and academic societies. Only with such infrastructure, can the professionals and students in the global health field receive academic training, conduct global health research, exchange and disseminate research findings, and promote global health practices [ 5 , 15 , 20 , 21 , 22 , 23 ].

Developmentally and historically, we have learned and will continue to learn global health from the WHO [ 1 , 4 , 24 , 25 ]. WHO’s projects are often ambitious, involving multiple countries, or even global in scope. Through research and action projects, the WHO has established a solid knowledge base, relevant theories, models, methodologies, valuable data, and lots of experiences that can be directly used in developing global health [ 26 , 27 , 28 , 29 ]. Typical examples include WHO’s efforts for global HIV/AIDS control [ 13 , 30 , 31 , 32 ], and the Primary Healthcare Programs to promote Health For All [ 33 , 34 ].

The definition of Global Health

From published studies in the international literature and our experiences in research, training, teaching and practice, our meeting reached a consensus-global health is a newly established branch of health sciences, growing out from medicine, public health and international health, with much input from the WHO. What makes global health different from them is that (1) global health deals with only medical and health issues with global impact [ 35 , 5 , 36 , 10 , 14 , 2 ] the main task of global health is to seek for global solutions to the issues with global health impact [ 7 , 18 , 37 ]; and (3) the ultimate goal is to use the power of academic research and science to promote health for all, and to improve health equity and reduce health disparities [ 7 , 14 , 15 , 18 , 38 ]. Therefore, global health targets populations in all countries and involves all sectors beyond medical and health systems, although global health research and practice can be conducted locally [ 39 ].

As a branch of medical and health sciences, global health has three fundamental tasks: (1) to master the spatio-temporal patterns of a medical and/or health issue across the globe to gain a better understanding of the issue and to assess its global impact [ 40 , 41 , 42 , 43 ]; (2) to investigate the determinants and influential factors associated with medical and health issues that are known to have global impact [ 15 , 40 , 41 , 42 , 43 ]; and (3) to establish evidence-based global solutions, including strategies, frameworks, governances, policies, regulations and laws [ 14 , 15 , 28 , 38 , 44 , 45 , 46 , 47 ].

Like public health, medicine, and other branches of sciences, global health should have three basic functions : The first function is to generate new knowledge and theories about global health issues, influential factors, and develop global solutions. The second function is to distribute the knowledge through education, training, publication and other forms of knowledge sharing. The last function is to apply the global health knowledge, theories, and intervention strategies in practice to solve global health problems.

Understanding the word “global”

Confusion in understanding the term ‘global health’ has largely resulted from our understanding of the word “global”. There are few discrepancies when the word ‘global’ is used in other settings such as in geography. In there, the world global physically pertains to the Earth we live on, including all people and all countries in the world. However, discrepancies appear when the word “global” is combined with the word “health” to form the term “global health”. Following the word “global” literately, an institution, a research project, or an article can be considered as global only if it encompasses all people and all countries in the world. If we follow this understanding, few of the work we are doing now belong to global health; even the work by WHO are for member countries only, not for all people and all countries in the world. But most studies published in various global health journals, including those in our GHRP, are conducted at a local or international level. How could this global health happen?

The argument presented above leads to another conceptualization: Global health means health for a very large group of people in a very large geographic area such as the Western Pacific, Africa, Asia, Europe, and Latin America. Along with this line of understanding, an institution, a research project or an article involving multi-countries and places can be considered as global, including those conducted in countries involved in China’s Belt and Road Initiative (BRI) [ 26 , 48 , 49 , 50 , 51 ]. They are considered as global because they meet our definitions of global health which focus on medical and health issues with global impact or look for global solutions to a medical or health issue [ 5 , 7 , 22 ].

One step further, the word ‘global’ can be considered as a concept of goal-setting in global health. Typical examples of this understanding are the goals established for a global health institution, for faculty specialized in global health, and for students who major or minor in global health. Although few of the global health institutions, scholars and students have conducted or are going to conduct research studies with a global sample or delivered interventions to all people in all countries, all of them share a common goal: Preventing diseases and promoting health for all people in the world. For example, preventing HIV transmission within Wuhan would not necessarily be a global health project; but the same project can be considered as global if it is guided by a global perspective, analyzed with methods with global link such as phylogenetic analysis [ 52 , 53 ], and the goal is to contribute to global implications to end HIV/AIDS epidemic.

The concept of global impact

Global impact is a key concept for global health. Different from other public health and medical disciplines, global health can address any issue that has a global impact on the health of human kind, including health system problems that have already affected or will affect a large number of people or countries across the globe. Three illustrative examples are (1) the SARS epidemic that occurred in several areas in Hong Kong could spread globally in a short period [ 11 ] to cause many medical and public health challenges [ 54 , 55 ]; (2) the global epidemic of HIV/AIDS [ 13 ]; and the novel coronavirus epidemic first broke out in December 2019 in Wuhan and quickly spread to many countries in the world [ 56 ].

Along with rapid and unevenly paced globalization, economic growth, and technological development, more and more medical and health issues with global impact emerge. Typical examples include growing health disparities, migration-related medical and health issues, issues related to internet abuse, the spread of sedentary lifestyles and lack of physical activity, obesity, increasing rates of substance abuse, depression, suicide and many other emerging mental health issues, and so on [ 10 , 23 , 36 , 42 , 57 , 58 , 59 , 60 ]. GHRP is expecting to receive and publish more studies targeting these issues guided by a global health perspective and supports more researchers to look for global solutions to these issues.

The concept of global solution

Another concept parallel to global impact is global solution . What do we mean by global solutions? Different from the conventional understanding in public health and medicine, global health selectively targets issues with global impact. Such issues often can only be effectively solved at the macro level through cross-cultural, international, and/or even global collaboration and cooperation among different entities and stakeholders. Furthermore, as long as the problem is solved, it will benefit a large number of population. We term this type of interventions as a global solution. For example, the 90–90-90 strategy promoted by the WHO is a global solution to end the HIV/AIDS epidemic [ 61 , 62 ]; the measures used to end the SARS epidemic is a global solution [ 11 ]; and the ongoing measures to control influenza [ 63 , 64 ] and malaria [ 45 , 65 ], and the measures taken by China, WHO and many countries in the world to control the new coronaviral epidemic started in China are also great examples of global solutions [ 66 ].

Global solutions are also needed for many emerging health problems, including cardiovascular diseases, sedentary lifestyle, obesity, internet abuse, drug abuse, tobacco smoking, suicide, and other problems [ 29 , 44 ]. As described earlier, global solutions are not often a medical intervention or a procedure for individual patients but frameworks, policies, strategies, laws and regulations. Using social media to deliver interventions represents a promising approach in establishment of global solutions, given its power to penetrate physical barriers and can reach a large body of audience quickly.

Types of Global Health researches

One challenge to GHRP editors (and authors alike) is how to judge whether a research study is global? Based on the new definition of global health we proposed as described above, two types of studies are considered as global and will receive further reviews for publication consideration. Type I includes projects or studies that involve multiple countries with diverse backgrounds or cover a large diverse populations residing in a broad geographical area. Type II includes projects or studies guided by a global perspective, although they may use data from a local population or a local territory. Relative to Type I, we anticipate more Type II project and studies in the field of global health. Type I study is easy to assess, but caution is needed to assess if a project or a study is Type II. Therefore, we propose the following three points for consideration: (1) if the targeted issues are of global health impact, (2) if the research is attempted to understand an issue with a global perspective, and (3) if the research purpose is to seek for a global solution.

An illustrative example of Type I studies is the epidemic and control of SARS in Hong Kong [ 11 , 67 ]. Although started locally, SARS presents a global threat; while controlling the epidemic requires international and global collaboration, including measures to confine the infected and measures to block the transmission paths and measures to protect vulnerable populations, not simply the provisions of vaccines and medicines. HIV/AIDS presents another example of Type I project. The impact of HIV/AIDS is global. Any HIV/AIDS studies regardless of their scope will be global as long as it contributes to the global efforts to end the HIV/AIDS epidemic by 2030 [ 61 , 62 ]. Lastly, an investigation of cardiovascular diseases (CVD) in a country, in Nepal for example, can be considered as global if the study is framed from a global perspective [ 44 ].

The discussion presented above suggests that in addition to scope, the purpose of a project or study can determine if it is global. A pharmaceutical company can target all people in the world to develop a new drug. The research would be considered as global if the purpose is to improve the medical and health conditions of the global population. However, it would not be considered as global if the purpose is purely to pursue profit. A research study on a medical or health problem among rural-to-urban migrants in China [ 57 , 58 , 60 ] can be considered as global if the researchers frame the study with a global perspective and include an objective to inform other countries in the world to deal with the same or similar issues.

Think globally and act locally

The catchphrase “think globally and act locally” presents another guiding principle for global health and can be used to help determine whether a medical or public health research project or a study is global. First, thinking globally and acting locally means to learn from each other in understanding and solving local health problems with the broadest perspective possible. Taking traffic accidents as an example, traffic accidents increase rapidly in many countries undergoing rapid economic growth [ 68 , 69 ]. There are two approaches to the problem: (1) locally focused approach: conducting research studies locally to identify influential factors and to seek for solutions based on local research findings; or (2) a globally focused approach: conducting the same research with a global perspective by learning from other countries with successful solutions to issues related traffic accidents [ 70 ].

Second, thinking globally and acting locally means adopting solutions that haven been proven effective in other comparable settings. It may greatly increase the efficiency to solve many global health issues if we approach these issues with a globally focused perspective. For example, vector-borne diseases are very prevalent among people living in many countries in Africa and Latin America, such as malaria, dengue, and chikungunya [ 45 , 71 , 72 ]. We would be able to control these epidemics by directly adopting the successful strategy of massive use of bed nets that has been proven to be effective and cost-saving [ 73 ]. Unfortunately, this strategy is included only as “simple alternative measures” in the so-called global vector-borne disease control in these countries, while most resources are channeled towards more advanced technologies and vaccinations [ 16 , 19 , 74 ].

Third, thinking globally and acting locally means learning from each other at different levels. At the individual level, people in high income countries can learn from those in low- and mid-income countries (LMICs) to be physically more active, such as playing Taiji, Yoga, etc.; while people in LMICs can learn from those in high income countries to improve their hygiene, life styles, personal health management, etc. At the population level, communities, organizations, governments, and countries can learn from each other in understanding their own medical and health problems and healthcare systems, and to seek solutions for these problems. For example, China can learn from the United States to deal with health issues of rural to urban migrants [ 75 ]; and the United States can learn from China to build three-tier health care systems to deliver primary care and prevention measures to improve health equality.

Lastly, thinking globally and acting locally means opportunities to conduct global health research and to be able to exchange research findings and experiences across the globe; even without traveling to another country. For example, international immigrants and international students present a unique opportunity for global health research in a local city [ 5 , 76 ]. To be global, literature search and review remains the most important approach for us to learn from each other besides conducting collaborative work with the like-minded researchers across countries; rapid development in big data and machine learning provide another powerful approach for global health research. Institutions and programs for global health provides a formal venue for such learning and exchange opportunities.

Reframing a local research study as global

The purpose of this article is to promote global health through research and publication. Anyone who reads this paper up to this point might already be able to have a clear idea on how to reframe his/her own research project or article to be of global nature. There is no doubt that a research project is global if it involves multiple countries with investigators of diverse backgrounds from different countries. However, if a research project targets a local population with investigators from only one or two local institutions, can such project be considered as global?

Our answer to this question is “yes” even if a research study is conducted locally, if the researcher (1) can demonstrate that the issue to be studied or being studied has a global impact, or (2) eventually looks for a global solution although supported with local data. For example, the study of increased traffic accidents in a city in Pakistan can be considered as global if the researchers frame the problem from a global perspective and/or adopt global solutions by learning from other countries. On the other hand, a statistical report of traffic accidents or an epidemiological investigation of factors related to the traffic accidents at the local level will not be considered as global. Studies conducted in a local hospital on drug resistance to antibiotics and associated cost are global if expected findings can inform other countries to prevent abuse of antibiotics [ 77 ]. Lastly, studies supported by international health programs can be packaged as global simply by broadening the vision from international to global.

Is Global Health a new bottle with old wine?

Another challenge question many scholars often ask is: “What new things can global health bring to public health and medicine?” The essence of this question is whether global health is simply a collection of existing medical and health problems packaged with a new title? From our previous discussion, many readers may already have their own answer to this question that this is not true. However, we would like to emphasize a few points. First, global health is not equal to public health, medicine or both, but a newly emerged sub-discipline within the public health-medicine arena. Global health is not for all medical and health problems but for the problems with global impact and with the purpose of seeking global solutions. In other words, global health focuses primarily on mega medical and health problems that transcend geographical, cultural, and national boundaries and seeks broad solutions, including frameworks, partnerships and cooperation, policies, laws and regulations that can be implemented through governments, social media, communities, and other large and broad reaching mechanisms.

Second, global health needs many visions, methods, strategies, approaches, and frameworks that are not conventionally used in public health and medicine [ 5 , 18 , 22 , 34 ]. They will enable global health researchers to locate and investigate those medical and health issues with global impact, gain new knowledge about them, develop new strategies to solve them, and train health workers to deliver the developed strategies. Consequently, geography, history, culture, sociology, governance, and laws that are optional for medicine and public health are essential for global health. Lastly, it is fundamental to have a global perspective for anyone in global health, but this could be optional for other medical and health scientists [ 40 , 41 ].

Global Health, international health, and public health

As previously discussed, global health has been linked to several other related disciplines, particularly public health, international health, and medicine [ 3 , 5 , 7 , 18 , 22 ]. To our understanding, global health can be considered as an application of medical and public health sciences together with other disciplines (1) in tackling those issues with global impact and (2) in the effort to seek global solutions. Thus, global health treats public health sciences and medicine as their foundations, and will selectively use theories, knowledge, techniques, therapeutics and prevention measures from public health, medicine, and other disciplines to understand and solve global health problems.

There are also clear boundaries between global health, public health and medicine with regard to the target population. Medicine targets patient populations, public health targets health populations in general, while global health targets the global population. We have to admit that there are obvious overlaps between global health, public health and medicine, particularly between global health and international health. It is worth noting that global health can be considered as an extension of international health with regard to the scope and purposes. International health focuses on the health of participating countries with intention to affect non-participating countries, while global health directly states that its goal is to promote health and prevent and treat diseases for all people in all countries across the globe. Thus, global health can be considered as developed from, and eventually replace international health.

Challenges and opportunities for China to contribute to Global Health

To pursue A Community with a Shared Future for Mankind , China’s BRI , currently involving more than 150 countries across the globe, creates a great opportunity for Chinese scholars to contribute to global health. China has a lot to learn from other countries in advancing its medical and health technologies and to optimize its own healthcare system, and to reduce health disparities among the 56 ethnic groups of its people. China can also gain knowledge from other countries to construct healthy lifestyles and avoid unhealthy behaviors as Chinese people become more affluent. Adequate materials and money may be able to promote physical health in China; but it will be challenging for Chinese people to avoid mental health problems currently highly prevalent in many rich and developed countries.

To develop global health, we cannot ignore the opportunities along with the BRI for Chinese scholars to share China’s lessons and successful experience with other countries. China has made a lot of achievements in public health and medicine before and after the Open Door Policy [ 49 , 78 ]. Typical examples include the ups and downs of the 3-Tier Healthcare Systems, the Policy of Prevention First, and the Policy of Putting Rural Health as the Priority, the Massive Patriotic Hygiene Movement with emphasis on simple technology and broad community participation, the Free Healthcare System for urban and the Cooperative Healthcare System for rural residents. There are many aspects of these initiatives that other countries can emulate including the implementation of public health programs covering a huge population base unprecedented in many other countries.

There are challenges for Chinese scholars to share China’s experiences with others as encountered in practice. First of all, China is politically very stable while many other countries have to change their national leadership periodically. Changes in leadership may result in changes in the delivery of evidence- based intervention programs/projects, although the changes may not be evidence-based but politically oriented. For example, the 3-Tier Healthcare System that worked in China [ 79 , 80 ] may not work in other countries and places without modifications to suit for the settings where there is a lack of local organizational systems. Culturally, promotion of common values among the public is unique in China, thus interventions that are effective among Chinese population may not work in countries and places where individualism dominates. For example, vaccination program as a global solution against infectious diseases showed great success in China, but not in the United States as indicated by the 2019 measles outbreak [ 81 ].

China can also learn from countries and international agencies such as the United Kingdom, the United States, the World Health Organization, and the United Nations to successfully and effectively provide assistance to LMICs. As China develops, it will increasingly take on the role of a donor country. Therefore, it is important for Chinese scholars to learn from all countries in the world and to work together for a Community of Shared Future for Mankind during the great course to develop global health.

Promotion of global health is an essential part of the Working Together  to Build a Community of Shared Future for Mankind. In this editorial, we summarized our discussions in the 2019 GHRP Editorial Board Meeting regarding the concept of global health. The goal is to enhance consensus among the board members as well as researchers, practitioners, educators and students in the global health community. We welcome comments, suggestions and critiques that may help further our understanding of the concept. We would like to keep the concept of global health open and let it evolve along with our research, teaching, policy and practice in global health.

Dunham GC. Today's global Frontiers in public health: I. a pattern for cooperative public health. Am J Public Health Nations Health. 1945;35(2):89–95.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kickbusch I. Health promotion: a global perspective. Can J Public Health. 1986;77(5):321–6.

CAS   PubMed   Google Scholar  

Kickbusch I. Global + local = glocal public health. J Epidemiol Community Health. 1999;53(8):451–2.

Kickbusch I. Mapping the future of public health: action on global health. Can J Public Health. 2006;97(1):6–8.

Article   PubMed   PubMed Central   Google Scholar  

Chen X. Understanding the development and perception of global health for more effective student education. Yale J Biol Med. 2014;87(3):231–40.

PubMed   PubMed Central   Google Scholar  

Bristol N. Obama's plans for US and global health. Lancet. 2008;372(9652):1797–8.

Article   PubMed   Google Scholar  

Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, et al. Towards a common definition of global health. Lancet. 2009;373(9679):1993–5.

Peluso MJ, Encandela J, Hafler JP, Margolis CZ. Guiding principles for the development of global health education curricula in undergraduate medical education. Med Teach. 2012;34(8):653–8.

Brown TM, Cueto M, Fee E. The World Health Organization and the transition from international to global public health. Am J Public Health. 2006;96(1):62–72.

Friedrich MJ. Global obesity epidemic worsening. Jama-Journal of the American Medical Association. 2017;318(7):603.

Google Scholar  

Hung LS. The SARS epidemic in Hong Kong: what lessons have we learned? J R Soc Med. 2003;96(8):374–8.

Institute of Medicine (US), Board on International Health. America's vital interest in global health: protecting our people, enhancing our economy, and advancing our international interests. Washington, D.C.: National Academies Press; 1997.

Katz IT, Ehrenkranz P, El-Sadr W. The global HIV epidemic what will it take to get to the finish line? Jama-Journal of the American Medical Association. 2018;319(11):1094–5.

Article   Google Scholar  

Kickbusch I. Global health diplomacy: how foreign policy can influence health. BMJ. 2011;342:d3154.

Ren R. The definition and characteristics of global health. Medicine & Philosophy. 2015;36(8A):1–3.

CAS   Google Scholar  

Strategies, The malERA Consultative Group on Integration. malERA: An updated research agenda for basic science and enabling technologies in malaria elimination and eradication. PLoS Med. 2017;14(11):e1002451.

Kickbusch I, Hein W, Silberschmidt G. Addressing global health governance challenges through a new mechanism: the proposal for a committee C of the world health assembly. J Law Med Ethics. 2010;38(3):550–63.

Merson MH, Black RE, Mills AJ. Global health: diseases, programs, systems and policies. Jones & Bartlett Learning, L.L.C: New York/Ontario/London; 2012.

The malERA Consultative Group on Integration Strategies. A research agenda for malaria eradication: cross-cutting issues for eradication. PLoS Med. 2011;8(1):e1000404.

Mao Z, Liu P, Xiang H. Reformation and renewal of the undergraduate education based on a global health perspective - an example of the College of Health at Wuhan University. Wuhan, China: Wuhan University Press; 2018.

Rowson M, Smith A, Hughes R, Johnson O, Maini A, Martin S, Yudkin JS, et al. The evolution of global health teaching in undergraduate medical curricula. Glob Health. 2012;8(1):35.

Rowson M, Willott C, Hughes R, Maini A, Martin S, Miranda JJ, Yudkin JS, et al. Conceptualising global health: theoretical issues and their relevance for teaching. Glob Health. 2012;8(1):36.

White SK. Public health at a crossroads: assessing teaching on economic globalization as a social determinant of health. Crit Public Health. 2012;22(3):281–95.

Khubchandani J, Simmons R. Going global: building a foundation for global health promotion research to practice. Health Promot Pract. 2012;13(3):293–7.

Kickbusch I, Silberschmidt G, Buss P. Global health diplomacy: the need for new perspectives, strategic approaches and skills in global health. Bull World Health Organ. 2007;85(3):230–2.

Agaku IT, Ayo-Yusuf OA, Vardavas CI, Connolly G. Predictors and patterns of cigarette and smokeless tobacco use among adolescents in 32 countries, 2007-2011. J Adolesc Health. 2014;54(1):47–53.

Nikaj S, Chaloupka FJ. The effect of prices on cigarette use among youths in the global youth tobacco survey. Nicotine Tob Res. 2014;16(S1):S16–23.

World Health Organization. WHO Framework Convention on Tobacco Control. Geneva, Switzerland World Health Organization; 2003.

Rao S, Aslam SK, Zaheer S, Shafique K. Anti-smoking initiatives and current smoking among 19643 adolescents in South Asia: findings from the global youth tobacco survey. Harm Reduct J. 2014;11(1):8.

Harman S. 15 years of 'War on AIDS': what impact has the global HIV/AIDS response had on the political economy of Africa? Rev Afr Polit Econ. 2015;42(145):467–76.

Raguin G, Girard PM. Toward a global health approach: lessons from the HIV and Ebola epidemics. Glob Health. 2018;14(1):1–4.

Stover J, Bertozzi S, Gutierrez JP, Walker N, Stanecki KA, Greener R, Ghys PD, et al. The global impact of scaling up HIV/AIDS prevention programs in low- and middle-income countries. Science. 2006;311(5766):1474–6.

Article   CAS   PubMed   Google Scholar  

Amofah GK. Ghana. Selective versus comprehensive primary health care. Trop Dr. 1994;24(2):76–8.

Article   CAS   Google Scholar  

Magnussen L, Ehiri J, Jolly P. Comprehensive versus selective primary health care: lessons for global health policy. Health Aff (Millwood). 2004;23(3):167–76.

Brown H. WHO puts cancer on global health agenda. Lancet Oncol. 2004;5(11):644.

Degenhardt L, Stockings E, Patton G, Hall WD, Lynskey M. The increasing global health priority of substance use in young people. Lancet Psychiatry. 2016;3(3):251–64.

Alonso PL, Brown G, Tanner M, Integratio, maIERA Consultative Grp. A Research Agenda for Malaria Eradication: Cross-Cutting Issues for Eradication. Plos Medicine. 2011;8(1):e1000399.

Stuckler D, McKee M. Five metaphors about global-health policy. Lancet. 2008;372(9633):95–7.

Beaglehole R, Bonita R. What is global health. Glob Health Action. 2010;3:5142.

Chen X, Chen DG. Statistical methods for global health and epidemiology. Basel, Switzerland: Springer; 2019.

Hao YT, Chen X. Research methods in global health (textbook). Beijing, China: People' Health Publication House; 2018.

Labonte R, Schrecker T. Globalization and social determinants of health: introduction and methodological background (part 1 of 3). Glob Health. 2007;3(1):5.

Labonte R, Schrecker T. Globalization and social determinants of health: the role of the global marketplace (part 2 of 3). Glob Health. 2007;3(1):6.

Aifah A, Iwelunmor J, Akwanalo C, Allison J, Amberbir A, Asante KP, Weber MB, et al. The Kathmandu declaration on global CVD/hypertension research and implementation science: a framework to advance implementation research for cardiovascular and other noncommunicable diseases in low- and middle-income countries. Glob Heart. 2019;14(2):103–7.

Feachem R, Sabot O. A new global malaria eradication strategy. Lancet. 2008;371(9624):1633–5.

Petersen PE. World health organization global policy for improvement of oral health--world health assembly 2007. Int Dent J. 2008;58(3):115–21.

Singh N. A new global malaria eradication strategy: implications for malaria research from an Indian perspective. Trans R Soc Trop Med Hyg. 2009;103(12):1202–3.

Grimm S. China-Africa cooperation: promises, pratice and prospects. Journal of Contemporary China. 2014;23(90):993–1011.

Tang K, Li ZH, Li WK, Chen L. China's silk road and global health. Lancet. 2017;390(10112):2595–601.

Witvliet MI, Arah OA, Stronks K, Kunst AE. A global study on lone mothers: exploring the associations of self-assessed general health with motherhood types and gender inequality in 32 countries. Womens Health Issues. 2014;24(2):e177–85.

Zhu S, Zhu W, Qian W, He Y, Huang J. A China - Vietnam collaboration for public health care: a preliminary study. Glob Health Res Policy. 2019;4(1):23.

Rife BD, Mavian C, Chen X, Ciccozzi M, Salemi M, Min J, Prosperi MC. Phylodynamic applications in 21(st) century global infectious disease research. Glob Health Res Policy. 2017;2(1):13.

Zhou S, Cella E, Zhou W, Kong WH, Liu MQ, Liu PL, Chen X, et al. Population dynamics of hepatitis C virus subtypes in injecting drug users on methadone maintenance treatment in China associated with economic and health reform. J Viral Hepat. 2017;24(7):551–60.

Lee A, Abdullah AS. Severe acute respiratory syndrome: a challenge for public health practice in Hong Kong. J Epidemiol Community Health. 2003;57(9):655–8.

Abdullah AS, Thomas GN, McGhee SM, Morisky DE. Impact of severe acute respiratory syndrome (SARS) on travel and population mobility: implications for travel medicine practitioners. J Travel Med. 2004;11(2):107–11.

Li Q, Guan XH, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med. 2020.

Chen XG, Yu B, Gong J, Wang PG, Elliott AL. Social capital associated with quality of life mediated by employment experiences: evidence from a random sample of rural-to-urban migrants in China. Soc Indic Res. 2018;139(1):327–46.

Guo Y, Chen XG, Gong J, Li F, Zhu CY, Yan YQ, Wang L. Association between spouse/child separation and migration-related stress among a random sample of rural-to-urban migrants in Wuhan China. Plos One. 2016;11(4):e0154252.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Sinyor M, Tse R, Pirkis J. Global trends in suicide epidemiology. Current Opinion in Psychiatry. 2017;30(1):1–6.

Yu B, Chen XG, Elliott AL, Wang Y, Li F, Gong J. Social capital, migration stress, depression and sexual risk behaviors among rural-to-urban migrants in China: a moderated mediation modeling analysis. Anxiety Stress and Coping. 2019;32(4):362–75.

Jamieson D, Kellerman SE. The 90 90 90 strategy to end the HIV pandemic by 2030: can the supply chain handle it? J Int AIDS Soc. 2016;19(1):20917.

Lima VD, St-Jean M, Rozada I, Shoveller JA, Nosyk B, Hogg RS, Montaner JSG, et al. Progress towards the United Nations 90-90-90 and 95-95-95 targets: the experience in British Columbia. Canada J Int AIDS Soc. 2017;20(3):e25011.

Friede M, Palkonyay L, Alfonso C, Pervikov Y, Torelli G, Wood D, Kieny MP. WHO initiative to increase global and equitable access to influenza vaccine in the event of a pandemic: supporting developing country production capacity through technology transfer. Vaccine. 2011;29(S1):A2–7.

Palkonyay L, Fatima H. A decade of adaptation: regulatory contributions of the World Health Organization to the global action plan for influenza vaccines (2006-2016). Vaccine. 2016;34(45):5414–9.

McCoy D, Kembhavi G, Patel J, Luintel A. The Bill & Melinda Gates Foundation's grant-making programme for global health. Lancet. 2009;373(9675):1645–53.

World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Geneva, Switzerland; 2020.

Abdullah AS, Tomlinson B, Cockram CS, Thomas GN. Lessons from the severe acute respiratory syndrome outbreak in Hong Kong. Emerg Infect Dis. 2003;9(9):1042–5.

Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. Lancet. 2006;367(9521):1533–40.

Naci H, Chisholm D, Baker TD. Distribution of road traffic deaths by road user group: a global comparison. Injury Prevention. 2009;15(1):55–9.

Kareem A. Review of global menace of road accidents with special reference to Malaysia- a social perspective. Malays J Med Sci. 2003;10(2):31–9.

Gubler DJ. The economic burden of dengue. Am J Trop Med Hyg. 2012;86(5):743–4.

Wettstein ZS, Fleming M, Chang AY, Copenhaver DJ, Wateska AR, Bartsch SM, Kulkarni RP, et al. Total economic cost and burden of dengue in Nicaragua: 1996-2010. Am J Trop Med Hyg. 2012;87(4):616–22.

Cheng H, Yang W, Kang W, Liu C. Large-scale spraying of bednets to control mosquito vectors and malaria in Sichuan. China Bull World Health Organ. 1995;73(3):321–8.

The malERA Consultative Group on Integration Strategies. A research agenda for malaria eradication: vector control. PLoS Med. 2011;8(1):e1000401.

Menzies NA, Hill AN, Cohen T, Salomon JA. The impact of migration on tuberculosis in the United States. Int J Tuberc Lung Dis. 2018;22(12):1392–403.

Liu Y, Chen XG, Li SY, Bin Y, Wang Y, Yan H. Path analysis of acculturative stress components and their relationship with depression among international students in China. Stress Health. 2016;32(5):524–32.

Li H, Liu XL, Cui D, Wang Q, Mao Z, Gang L, Sun J, et al. Estimating the direct medical economic disease burden of healthcare associated infections in Chinese public tertiary hospitals. 2017;29(5):440-450. Asia Pac J Public Health. 2017;29(5):440–50.

Blumenthal D, Hsiao W. Lessons from the East - China's rapidly evolving health care system. N Engl J Med. 2015;372(14):1281–5.

Chen Z. Launch of the health-care reform plan in China. Lancet. 2009;373(9672):1322–4.

Liu XZ, Wang JL. An introduction to China’s health care system. J Public Health Policy. 1991;12(1):104–16.

Patel M, Lee AD, Redd SB, Clemmons NS, McNall RJ, Cohn AC, Gastanaduy PA. Increase in measles cases - United States, January 1-April 26, 2019. Am J Transplant. 2019;19(7):2127–30.

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Acknowledgements

We would like to thank those who had provided their comments for the improvement of the manuscript.

The work is funded by the journal development funds of Wuhan University.

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Global Health Institute, Wuhan University, Wuhan, China

Xinguang Chen, Hao Li, Xiaohui Liang, Zongfu Mao, Nan Wang, Peigang Wang & Tingting Wang

Department of Epidemiology, University of Florida, Florida, USA

Xinguang Chen

School of Health Sciences, Wuhan University, Wuhan, China

Hao Li, Xiaohui Liang, Zongfu Mao, Nan Wang, Peigang Wang, Tingting Wang, Hong Yan & Yuliang Zou

Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK

Don Eliseo Lucero-Prisno III

Global Health Research Center, Duke Kunshan University, Kunshan, China

Abu S. Abdullah

Duke Global Health Institute, Duke University, Durham, North Carolina, USA

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Jiayan Huang

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Charlotte Laurence

School of Public Health, Guangxi Medical University, Guangxi, China

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Chen XG wrote the manuscript. LI H organized the meeting, collecting the comments and editing the manuscript. Lucero-Prisno DE integrated all the comments together. Abdullah AS, Huang JY, Laurence C, Liang XH, Ma ZY, Ren R, Wu SL, Wang N, Wang PG and Wang Tt all participated in the discussion and comments of this manuscript. Laurence C and Liang XH both provided language editing. The author(s) read and approved the final manuscript

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Chen, X., Li, H., Lucero-Prisno, D.E. et al. What is global health? Key concepts and clarification of misperceptions. glob health res policy 5 , 14 (2020). https://doi.org/10.1186/s41256-020-00142-7

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DOI : https://doi.org/10.1186/s41256-020-00142-7

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Reimagining the Future of Global Health Initiatives: Final Report Release

30/08/23 News

We are thrilled to announce the release of the final report from our research project, “ Reimagining the Future of Global Health Initiatives .” This report delves deep into the intricate world of Global Health Initiatives (GHIs), offering invaluable insights into their trends, challenges, and positive contributions that are shaping the global health landscape.

Uncover the Global Health Landscape

In an ever-evolving world, the realm of global health is marked by both opportunities and complexities. Our report takes a closer look at the dynamic trends that are shaping the future of global health initiatives. From innovative financing strategies that are revolutionizing healthcare funding to unforeseen outcomes that have sparked new discussions, this report is a treasure trove of knowledge for those invested in the world of health.

We invite you to dive into the rich insights presented in this report. Whether you’re a healthcare professional, researcher, policymaker, or simply someone passionate about global health, there’s something for everyone in this comprehensive study. You can read it online or dowload the Final Report , the Research Brief, and the Summary Notes .

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Dismuss uses his bicycle ambulance to transport a young boy with malaria to the nearest clinic. He is a volunteer community healthcare worker in Chongwe district, Zambia and is trained to test for common diseases and administer basic drugs. His priority is to transport more serious malaria cases to the clinic, 14 km away, where they can be treated.

Future of Global Health Initiatives process

Over the last two decades, Global Health Initiatives have contributed to enormous progress in protecting lives and improving the health of people globally.

However, as the epidemiological, financial, and political landscape across the world shifts and brings new challenges, there is a need to think about how their roles and responsibilities could evolve to most efficiently, effectively and equitably contribute to global health progress over the next 15 to 20 years.

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The Future of Global Health Initiatives process aims to review the roles and responsibilities of Global Health Initiatives, build consensus for change, and catalyse collective action.

To do so it brings together a wide range of partners, including representatives from governments, global and regional health organisations, research institutions and civil society. The process will seek to re-balance the power dynamics between the donor and implementing countries, maximise lasting health impacts, and simplify the landscape for mobilising and delivering funds. 

What we want to achieve  

The Future of Global Health Initiatives (FGHI) process seeks to achieve the following objectives:  

• Global Health Initiatives are more efficient, effective and equitable in complementing and strengthening health system capacities and delivering health impacts.
• Financing streams across Global Health Initiatives – and the broader health architecture at national, regional and global levels – are better balanced and coordinated, with stronger mutual accountability for meeting current and future global health needs.     
• Global Health Initiatives incentivise increased and sustained domestic investments in health that are more efficiently, effectively and equitably allocated, implemented and accounted for to achieve universal health coverage. 

In doing so, it will learn from and build on other ongoing or recent alignment efforts in the health sector, such as the SDG3 Global Action Plan, the Global Financing Facility Alignment Working Group, and the work of the International Health Partnership and related initiatives.

Why is it needed and why now?  

Global Health Initiatives have contributed to enormous progress in protecting lives and improving the health of people globally, including significant progress against individual diseases like polio, malaria, tuberculosis and HIV, and increasing coverage of specific interventions like vaccines. 

However, there are issues of fragmentation and inefficiencies with the current system, and priority setting does not always align with collective and national health needs. 

The Future of Global Health Initiatives process therefore seeks to:

Address power imbalances in priority setting and decision making in global health architecture. 

Remove inefficiencies created by the fragmentation of Global Health Initiatives’ operating and funding procedures. 

Ensure sufficient prioritisation and coordination of health system strengthening investments for universal health coverage. 

Respond to political and economic shifts that present challenges for international resource mobilisation. 

Reflect the impact of significant epidemiological and demographic changes over the last two decades and projected for the future.

Respond to the evolving nature of the wider global health architecture as new actors and initiatives emerge and regional bodies assume an increasingly prominent role.  

Global Health Initiatives (GHIs)

Global Health Initiatives is a term used to refer to organisations that integrate the efforts of stakeholders around the world to mobilise and disburse funds to address health challenges, and do so by supporting the implementation of health programmes in low- and middle-income countries.

This includes the Global Funds to Fight AIDS, TB and Malaria, and Gavi the Vaccine Alliance, UNITAID and Global Financing Facility. International Financial or UN Institutions themselves are not the focus of the process, but their vital complementary role will be considered.

How the process will work  

Following an initial scoping and consultation period, the process was formally initiated in summer 2022 and is expected to run through 2023.

It is led by two Co-Chairs: Dr. Mercy M. Mwangangi, Chief Administrative Secretary, Ministry of Health, Kenya; and John-Arne Røttingen, Ambassador for Global Health, Ministry of Foreign Affairs, Norway. They are complemented by a multi-stakeholder Steering Group and a broad coalition of interested organisations and governments, and supported by the Future of Global Health Initiatives Secretariat, led by Linda Muller.

As a member of the Steering Group, Wellcome will work with the Co-Chairs and partners to drive the process forward. Wellcome will play a critical and central role in the process’s Research and Learning Task Team, and host and fund the FGHI Secretariat.

More information  

• Global Health Initiatives Brief – English PDF 196.6 KB
• Global Health Initiatives Brief – French PDF 194.7 KB
• Global Health Initiatives Brief – Spanish PDF 158.3 KB
• Watch the recording of a webinar hosted by the co-chairs to introduce the process

Contact us  

For further information, please contact Clare Battle

[email protected]

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WHO and Its Impact on Global Health Issues Essay

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The World Health Organization (WHO) is a focused agency of the United Nations (UN) that functions as a coordinating authority on global public health issues. When diplomats met to form the United Nations in 1945, one of the things they discussed an gave importance to was setting up a global health organization and incidentally, it was Jawaharlal Nehru, the first prime minister of independent India who proposed the establishment of such an organization. World Health Organization’s structure was convened on 7 April 1948, a date which is now celebrated as World Health Day throughout the world each year. It is a well endowed subsidiary of the UN and a constituent of the United Nations Development Group with its center of operations in Geneva, Switzerland.

The basic function of the World Health Organization, as stated in its constitution in the second chapter, article 1, is to take the world’s health matters in its hands and take charge for coordinating efforts to generally enhance public health throughout the world by aiming to provide each and every human being on earth access to fundamental and vital healthcare. Eradicating the world of poverty and health diseases, creating an interface between the developed and developing nations when pertaining to health issues, patronizing and supporting health programs in developing nations, coordinating and overseeing the procurement of health services, immersing in disease inspection and analysis, involving itself in promoting health and also to imparting health education, collaborating with governments and administrations all over the world to endorse health promotional programs are some of the other aims and objectives of the WHO.

The issues which are the center of attention of the World Health Organization are:

• Women’s Health
• Health In Africa
• Eradication of communicable diseases

Dr Margaret Chan, the Director-General of World Health Organization said; “I want my leadership to be judged by the impact of our work on the health of two populations: women and the people of Africa.”

It is very difficult to measure the achievements of the WHO is quantitative terms nevertheless it is possible to recognize certain positive achievements. Its first major accomplishment was the eradication of smallpox by conducting vast vaccination programs in 1979. Since then, the WHO has turned its attention to other diseases such as polio, leprosy and malaria, which have been controlled or are on the verge of eradication.

New international Child Growth Standards for infants and young children were published by the WHO in 2001. They provide guidance for the first time about how every child in the world should grow. The publication of the first report on the health of people in Africa underscores the fact that the WHO Africa Region, in which some 738 million people live, is coming up with its own solutions to Africa’s health problems.

WHO also initiated campaigns against the consumption of tobacco and each year WHO celebrates the convention of the WHO Framework on Tobacco Control also known as ‘No Tobacco Day’. Since it was inception by the World Health Assembly in 2003, 172 countries and the European Union have become Parties to the WHO FCTC. More than one billion people in 19 countries are now covered by WHO laws which require the printing of large, graphic health warnings on packages of tobacco.

All in all the extensive list of achievements of the WHO amounts to an overall achievement of considerable magnitude of which the organization and not least its dedicated staff and inspiring director general Dr Margaret Chan can well be proud.

Yet with all this work done the WHO cannot rest content. There is so much more to left to do.

Bibliography

“WHO | World Health Organization.” Web. 2011.

“The World Health Organization: Enlightened Goals and Remarkable Achievements-Vegetarian Era-The Supreme Master Ching Hai Hai News Magazine.151.” Web. 2011.

“Origins, History, and Achievements of the World Health Organization.” Web. 2011.

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Global Health Care, Essay Example

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Introduction

Global health care is a challenging phenomenon that supports the development of new perspectives and approaches to solving global health concerns, including nutrition, infectious disease, cancer, and chronic illness. It is important to address global health as a driving force in international healthcare expenditures because it represents an opportunity for clinicians throughout the world to collaborate and to address global health concerns to achieve favorable outcomes. Global healthcare in the modern era includes the utilization of technology to support different population groups and to address different challenges as related to global health problems that impact millions of people in different ways. These challenges demonstrate the importance of large-scale efforts to eradicate disease, to prevent illness, and to manage disease effectively through comprehensive strategies that encourage communication and collaboration across boundaries.

Global health care incorporates a number of critical factors into play so that people throughout the world are given a chance to live and to lead a higher quality of life. The World Health Organization (WHO) is of particular relevance because this organization supports global health initiatives and large-scale impact projects throughout the world (Sundewall et.al, 2009). The WHO recognizes the importance of developing strategies to address global health concerns by pooling resources in order to ensure that many population groups are positively impacted by these initiatives (Sundewall et.al, 2009). The WHO also collaborates with government bodies throughout the world to address specific concerns that are relevant to different population groups, such as infectious diseases, many of which ravage populations in a significant manner (Fineberg and Hunter, 2013). In this context, it is observed that global health has a significant impact on populations and their ability to thrive, given the high mortality rates of some diseases in less developed nations (Fineberg and Hunter, 2013). Therefore, it is expected that there will be additional frameworks in place to accommodate the needs of populations and the resources that are required to achieve favorable outcomes (Fineberg and Hunter, 2013).

In addition to the WHO, there are many other international organizations that support global health and disease in different ways. For example, The United Nations Children’s Fund (UNICEF) supports large-scale global health efforts to support the world’s children (imva.org, 2013). UNICEF works in conjunction with many governments and other sources of funding in order to accomplish its objectives related to child health and wellbeing (imva.org, 2013). UNICEF spends significant funds on many focus areas, including the preservation of child health, nutrition, emergency support, and sanitation in conjunction with local water supplies (imva.org, 2013). In addition, the United States Agency for International Development (USAID) provides support in many areas, including a primary focus on healthcare in developing nations (imva.org, 2013).

Leininger’s Culture Care Theory is essential in satisfying the objectives of global health because it supports an understanding of the issues related to cultural diversity and how they impact healthcare practices throughout the world (Current Nursing, 2012). This theory embodies many of the differences that exist in modern healthcare practices and supports a greater understanding of the issues that are most relevant on a global scale (Current Nursing, 2012). This theory is applicable because it represents a call to action to consider cultural differences when providing care and treatment to different population groups, but not at the expense of the quality of care that is provided (Current Nursing, 2012). In many countries, the provision of care is largely dependent on cultural diversity and customs, which is essential to a thriving healthcare system; however, diversity must also incorporate the concept of providing maximum care for an individual in need of treatment (Current Nursing, 2012).

Professional nursing is highly relevant to global health because nurses address some of the most critical challenges in providing care and expanding access to treatment for millions of people throughout the world. However, it is also important for nurses working with global health initiatives to recognize the importance of these directives and to consider ways to improve quality of care without compromising principles or other factors in the process. These efforts will ensure that nurses maximize their knowledge and understanding of global health and its scope in order to achieve positive outcomes for people in desperate need of healthcare services throughout the world. Nurses must collaborate with small and large-scale organizations regarding global health issues so that population needs are targeted and are specific. These efforts will ensure that patients are treated in areas where healthcare access is severely limited.

Global health represents a significant set of challenges for clinicians throughout the world. It is important to recognize these concerns and to take the steps that are necessary to provide patients with the best possible outcomes to achieve optimal health. The scope of global health concerns is significant; therefore, it is important to address these concerns and to take the steps that are necessary to collaborate and promote initiatives to fight global health problems. When these objectives are achieved using the knowledge and expertise of nurses, it is likely that there will be many opportunities to treat patients and to educate them regarding positive health. With the assistance of large global organizations, nurses play an important role in shaping outcomes for women throughout the world.

Current Nursing (2012). Transcultural nursing. Retrieved from http://currentnursing.com/nursing_theory/transcultural_nursing.html

Fineberg, H.V., and Hunter, D. J. (2013). A global view of health – an unfolding series. T he New England Journal of Medicine, 368(1), 78-79.

Imva.org (2013). Bilateral agencies. Retrieved from http://www.imva.org/Pages/orgfrm.htm

Sundewall, J., Chansa, C., Tomson, G., Forsberg, B.C., and Mudenda, D. (2009). Global health initiatives and country health systems. The Lancet, 374, 1237.

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You are here, global health initiatives.

The Global Fund and Gavi, the Vaccine Alliance are the main institutions that provide substantial funding to eligible countries in the Region. Seven countries – Afghanistan, Djibouti, Pakistan, Somalia, Sudan, Syrian Arab Republic and Yemen – are eligible for Gavi support on immunization and health system strengthening, and 12 are eligible for Global Fund grants, including the seven supported by Gavi.

Protracted social and political unrest in most grant-recipient countries continues to be a major challenge. Insecurity in many places hampers access to social services with the health sector being the worst affected, and the loss of human capital has severely weakened health services and systems in affected countries. Furthermore, global health initiatives have created parallel systems that undermine the holistic approach for health system development, and the principles of external aid, such as ownership and harmonization, are not adequately applied.

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Article Contents

Introduction, conclusions and recommendations, acknowledgements, the effects of global health initiatives on country health systems: a review of the evidence from hiv/aids control.

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Regien G Biesma, Ruairí Brugha, Andrew Harmer, Aisling Walsh, Neil Spicer, Gill Walt, The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control, Health Policy and Planning , Volume 24, Issue 4, July 2009, Pages 239–252, https://doi.org/10.1093/heapol/czp025

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This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries’ national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions.

Global health initiatives (GHIs) have enabled wider stakeholder participation in service delivery while often having early negative systems effects through establishing parallel bodies and processes that are poorly coordinated, harmonized and aligned with national systems.

Over time, GHIs have learned to better utilize country systems and support national disease control efforts, while making least progress in enabling countries to implement coordinated financial management and human resource strategies.

Independent longitudinal evaluations of GHIs are needed—especially at district, facility and community levels—to track developments and provide timely information to recipient countries, GHIs, civil society organizations and development agencies.

The past 10 years have witnessed a proliferation of what are commonly called global health initiatives (GHIs). They were put in place as an emergency response to accelerate the scale-up of control of the major communicable diseases, especially HIV/AIDS. GHIs are characterized by their ability to mobilize huge levels of financial resources, linking inputs to performance; and by the channelling of resources directly to non-governmental civil society groups (Caines 2005 ). Three GHIs—the World Bank's Multi-country HIV/AIDS Programme (MAP), the Global Fund to Fight AIDS, TB and Malaria, and The President's Emergency Plan For AIDS Relief (PEPFAR) (see Table 1 for main features)—are contributing more than two-thirds of all direct external funding to scaling up HIV/AIDS prevention, treatment and care in resource-poor countries (GFATM 2007 ; Oomman et al . 2007 ). They have leveraged high-level political support for HIV/AIDS at the global level and captured the attention of country-level stakeholders.

Main characteristics and HIV/AIDS commitments from the three GHIs (in millions of constant US$)

* Sources : OECD CRS database (last accessed 20 November 2008), Oomman et al . ( 2007 ).

Surprisingly, predictions that GHIs were likely to have profound effects on recipient country health systems (Brugha and Walt 2001 ) remain only partially explored (Brugha 2008 ; Yu et al . 2008 ), and speculation rather than systematic review of evidence characterizes current understanding of this major shift towards disease-specific funding, and its impact on health systems in recipient countries. Analysis has focused most closely on the Global Fund, and where analysis has been conducted on MAP and PEPFAR, lessons learned have not been collated and widely disseminated. The purpose of our review, therefore, is to systematically review, discuss and make recommendations for global and country policy makers around future evidence needs, based on available empirical data from countries on the specific effects on country health systems of these three GHIs.

In this review, we follow Brugha ( 2008 ) where, based on functions rather than governance structure, a GHI is defined as: ‘a blueprint for financing, resourcing, coordinating and/or implementing disease control across at least several countries in more than one region of the world’. According to this definition, GHIs may be bilateral agency—government to government—aid mechanisms, as in the case of PEPFAR; they can be established by a multilateral agency, as in the case of the World Bank's MAP; or they may be public-private partnerships, as in the case of the Global Fund. What characterizes them as GHIs is that they use uniform approaches to applying large levels of resources for HIV/AIDS control across a range of different countries and regions. 1 Our analysis of the effects of GHIs on country health systems focuses primarily on the effects that they have on those organizations, institutions and resources that produce actions whose primary purpose is to improve health (WHO 2000), which includes public, non-profit and for-profit private sectors, as well as international and bilateral donors, foundations and voluntary organizations involved in funding or implementing health activities at central, regional, district, community and/or household levels (Islam 2007 ).

Search strategy

In late 2007, we conducted a review of key documents, initially using as search terms research themes derived from a three-country study of the effects of the Global Fund (Stillman and Bennett 2005 ) and a draft of a policy review on GHIs (Brugha 2008 ). These themes and the names of the three selected GHIs were used as search terms for conducting a comprehensive search of six databases (AIDS Portal, CAB Direct, ELDIS, POPLINE, PubMed, and Web of Knowledge) for the period 2002–07. 2 We also performed internet searches for grey literature, reviewing the websites of three global health organizations (The World Bank's Independent Evaluation Group, the Global Fund Evaluation Library, and PEPFAR), and the research archives of three global health research institutes (Centre for Global Development, the UK Department for International Development Health Resource Centre, and Partnerships for Health Reform). Additional publications were obtained through reference lists of identified papers and by contacting key informants in the field.

Criteria for selection

Three authors examined the list of references generated by the search and independently assessed the retrieved studies for inclusion using the following criteria: This review does not include broad overviews of secondary material or ‘grey’ literature (for example, policy briefs, media or journal ‘comments’). We excluded studies restricted to data collection only at the global level, those based only on secondary data, and reviews and commentaries. This was sometimes a difficult judgement as some important reviews contained or cited some relevant primary data, but were excluded if these could not be directly sourced from papers or reports in the public domain.

Reports and papers must provide data about one or more of the key research themes as it relates to one or more of the three HIV/AIDS GHIs: Global Fund, PEPFAR or World Bank MAP;

Reports and papers must present primary data collected at the country level;

There must be some outline of methods, i.e. some explanation of how data were collected and analysed and how findings were derived;

The data are ‘original’. This might take the form of (i) primary qualitative or quantitative research findings; and (ii) external or internal multi-country evaluations of one or more of the GHIs.

A health systems framework for GHIs

Drawing on the conceptual framework for analysing system-wide effects of the Global Fund developed by Bennett and Fairbank ( 2003 ) and selected national-level effects reported in a policy review (Brugha 2008 ), a draft health systems framework was developed. This was composed of three health system's functions: policy development, policy implementation and service delivery. Given the lack of published evidence, 2002–07, on the effects of these GHIs on focal and non-focal services, the framework was shortened and focused on specific themes under policy development and policy implementation. Policy development reflected global concerns around country ownership, harmonization and alignment of global initiatives with national priorities and policies, as expressed in the Paris Declaration on Aid Effectiveness (OECD 2005 ). Policy implementation explored four cross-cutting health systems themes: coordination and planning, stakeholder engagement, monitoring and evaluation, and human resources (see Table 2 ). As new studies provide additional evidence, the framework can be expanded to include GHI effects on infrastructure and availability of drugs and other equipment; on coverage, equity and access to services; and the effects on non-focal, non-GHI supported services. Under each of these themes, we first present and interpret negative effects, which often correspond with the early effects of the GHIs, followed by positive effects and lessons learned by GHIs across this period.

Framework for assessing the published effects of GHIs on national health systems

Adapted from the SWEF framework by Bennett & Fairbank ( 2003 ) and Brugha ( 2008 ).

Description of studies

Thirty-one reports, where data were collected between 2002 and 2007, met the inclusion criteria (see Table 3 ). Some were disseminated both as individual and as cross-country outputs, notably the four-country Global Fund Tracking Study and the four-country SWEF (System Wide Effects of the Fund) studies. All were descriptive cross-sectional studies. A limited number of studies in this review have collected data both at the national and sub-national level, notably the SWEF study in Georgia, Benin and Ethiopia (Curatio 2004 ; Banteyerga et al . 2006 ; Gbangbadthore et al . 2006 ) and some others (GFATM 2004 ; McKinsey 2005 ; Kelly et al . 2006 ). Most of the studies included in this review used mainly or wholly qualitative methods (in-depth interviews).

Included studies with main characteristics

GF = Global Fund.

National policy development

Alignment to national policy, plans and priorities for health.

Negative effects of all three GHIs were reported by most early studies, including examples of how GHIs distracted governments from coordinated efforts to strengthen health systems through distorting national priorities and through imposing donor implementation conditions (Brugha et al . 2004 ; Grace 2004 ; World Bank 2004 ; McKinsey 2005 ; Stillman and Bennett 2005 ). The Global Fund aims to support programmes that reflect local priorities and fit within existing country structures, but in practice the extent to which this occurred varied widely (Stillman and Bennett 2005 ). The Fund rejected Uganda's 2002 Round One cross-cutting systems-strengthening proposal, requiring Uganda to break it into disease-specific components (Donoghue et al . 2005a ). In response, the Government established a discrete project management unit, which it and its donor partners viewed in 2003 as a distortion of Uganda's policy of channelling all funds to support a coordinated national health sector strategy. Pressure from World Health Organization (WHO) consultants led to Tanzania applying for Global Fund support for an anti-retroviral treatment programme, in place of the government's priority to fund a programme on orphans and children (Starling et al . 2005a ). Concerns were reported about PEPFAR-imposed policy prescriptions such as disallowing grant recipients from providing counselling on abortion and promotion of abstinence-only prevention approaches (ITPC 2005 ). An evaluation commissioned by the US Congress reported that PEPFAR's commitment to country ownership had been undermined by its rigid budget allocations to specific control measures (Sepulveda et al . 2007 ). Oomman et al . ( 2007 ) reported that PEPFAR's funding allocations were remarkably consistent despite epidemiological and health systems’ differences across Mozambique, Uganda and Zambia. This suggested that global earmarks and donor conditionalities were driving funding allocations regardless of countries’ diseases, health needs and priorities.

GHI-imposed priorities and funding decisions also reflected country systems’ weaknesses. An evaluation of the World Bank MAP reported that its approach was undermined by countries lacking national plans that prioritized the components of an HIV/AIDS programme according to their importance or anticipated effectiveness (OED 2005 ). In the early years of MAP, most Ministries of Health had been slow to respond to the HIV epidemic and some felt disempowered by MAP's support to a multisectoral response which channelled funds to other ministries in the fight against AIDS (World Bank 2004 ). The World Bank's interim review found that governments’ multisectoral response to the MAP had been disappointing. The different ministries’ sectoral plans lacked inter-sectorality and had not moved beyond their own workplace interventions to consider programmes for their beneficiaries such as students (Education) and farmers (Agriculture). Despite these early concerns, MAP was evaluated in 2007 as having succeeded in promoting a multisectoral response over the course of its 7 years (Gorgens-Albino et al . 2007 ), which corresponded with positive findings from an independent study in Uganda (Donoghue et al . 2005b ) indicating that GHI approaches had promoted lesson-learning by governments.

Global Fund and PEPFAR have also reportedly learned lessons and modified their processes over time. Studies across 2002–07 suggest that the Global Fund was beginning to adapt its early approach to fit with countries’ priorities for aligning new funds with country systems. In 2006, it was seen as more supportive of Ethiopia's decentralization policies than in 2005 (Banteyerga et al . 2005 ; Banteyerga et al . 2006 ). A follow-up study in Benin showed that the Global Fund was becoming better aligned with Benin's policies on partnership, although the planning of activities remained top-down, which conflicted with bottom-up processes supported by national health policy (Gbangbadthore et al . 2006 ). The US evaluation reported that recipient governments perceived PEPFAR's Country Operational Plans as becoming better aligned with national plans over time (Sepulveda et al . 2007 ). In Mozambique, while PEPFAR remained outside of the Sector Wide Approach (SWAp) pooled mechanism for funding the health and HIV/AIDS sectors, its representatives did participate in the annual planning activities undertaken by the Ministry of Health and National AIDS Council (Oomman et al . 2007 ). In Ethiopia, PEPFAR was working with the government to align with its priorities, although it was channelling its funds to its preferred implementing partners (Banteyerga 2006 ).

Donor harmonization and aid mechanisms

Negative effects on donor harmonization were reported in the early years of the GHIs. Those such as the Global Fund that lacked a country presence were radically new financing mechanisms in the international aid architecture; and they had not agreed with partners about their respective roles and responsibilities (McKinsey 2005 ). Although all of these GHIs had stated their willingness to harmonize their activities with other partners, the reality was often different. For example, the World Bank's review of MAP recommended that it and other donors should adopt ‘The Three Ones’ principles of harmonization: one strategic framework, one national authority and one monitoring and evaluation system for HIV/AIDS (World Bank 2004 ). However, MAP projects themselves continued to burden government officials with extensive and complex procedural and reporting requirements (Oomman et al . 2007 ).

An early synthesis of studies compiled by the Global Fund reported little harmonization between the Global Fund and pre-existing planning and funding mechanisms, such as SWAps and joint interagency committees (GFATM 2004 ). Later, Wilkinson et al . ( 2006 ) reported variable experiences of the Global Fund across different countries. While it supported donor harmonization and alignment efforts in Cambodia, Nigeria and Namibia, it was reportedly undermining these efforts in Sri Lanka and Cameroon, through requiring separate reporting systems with associated transaction costs. PEPFAR's requirement of US Federal Drugs Administration approval of antiretroviral drugs has prevented it relying on the WHO prequalification for quality assurance on which most donors and countries rely (Sepulveda et al . 2007 ). Other barriers to harmonization and collective donor action have included PEPFAR's requirement that results be attributable to its inputs, and its lack of transparency and unwillingness to involve other donors in its own annual planning processes, which have been considered procurement-sensitive (Sepulveda et al . 2007 ).

There is evidence, over time, that the GHIs—especially the Global Fund—have learned lessons and begun to harmonize their approaches and align them with governments. Follow-up studies across 2004 and 2005 in Benin and Ethiopia, where the Global Fund and PEPFAR signed a memorandum of understanding, reported significant improvements in GHI harmonization (Stillman and Bennett 2005 ; Banteyerga 2006 ). The Global Fund's agreement in 2004 to allow its funds be channelled through Mozambique's SWAp, the Common Fund, was seen as a pioneering example of how disease-specific programmes can learn to adapt to and strengthen country systems (McKinsey 2005 ). In Mozambique, the World Bank MAP followed the Global Fund's lead, but PEPFAR remained outside of the SWAp as PEPFAR does not support Ministry of Finance fund management processes (McKinsey 2005 ; Oomman et al . 2007 ). However, despite not being able to contribute funds directly to the SWAp, it had become an active participant in donor partnerships that aimed to harmonize donor and country activities (Oomman et al . 2007 ).

The integration of Global Fund support into Malawi's SWAp to fund its integrated service delivery approach was perceived as positive for its sustainability (Mtonya and Chizimbi 2006 ). The MAP mainly focused its harmonization activities through National AIDS Councils (NACs), where it contributed to pooled-funding to the NAC's Integrated Annual Work Plan for 2003–2008 (Mtonya and Chizimbi 2006 ). In other countries, MAP has contributed funds to support implementation of Global Fund plans, and several MAP projects have implemented joint supervision missions (Gorgens-Albino et al . 2007 ).

Policy implementation

Coordination and planning structures.

The three-disease focus of the Global Fund has required the establishment of a new planning structure: the Country Coordination Mechanism (CCM); and coordination has continued to be a contentious issue for national planners (Wilkinson et al . 2006 ). The result has been duplication in planning for HIV/AIDS control, between CCMs and national AIDS councils. In Uganda, this led to competition between the MoH and the Uganda AIDS Commission for control and funds (Donoghue et al . 2005b ). In Malawi, it was reported that there were parallel planning structures for the NAC Integrated National Work Plan and the SWAp Programme of Work, which Global Fund support had aggravated (Mtonya and Chizimbi 2006 ). The McKinsey study ( 2005 ) found that in Tanzania and the Democratic Republic of Congo there were at least four committees overseeing HIV/AIDS control, with little communication between them about their activities. Respondents in Angola believed there were too many coordinating bodies that did not meet the country's needs (McKinsey 2005 ).

The World Bank, which endorsed the UNAIDS ‘Three Ones’ principles, had a simpler task in that it worked with existing national AIDS councils (OED 2005 ). However, several studies reported longstanding weaknesses in NACs, which have not provided consistent leadership and oversight (Donoghue et al . 2005a ; ITPC 2005 ; Starling et al . 2005a ). Their secretariats have often become implementation agencies rather than coordinators and facilitators (World Bank 2004 ). One three-country study reported that preparation of annual country operational plans, a condition of PEPFAR support, consumed considerable time and effort of recipient organizations in Uganda, Zambia and Mozambique (Oomman et al . 2007 ). While duplication of planning structures has persisted, some positive effects of GHIs on coordination and planning have been reported. In Malawi, after a USAID policy project study in 2004 had pointed to the multiplicity of HIV/AIDS coordinating structures, the Malawi Partnership Forum was created in 2005 as a central coordination structure overarching all existing mechanisms (Mtonya and Chizimbi 2006 ).

Coordination and planning processes

Several studies have reported systemic weaknesses in CCM governance, such as suboptimal communication between its members, and a lack of trust between government and non-government sectors (Brugha et al . 2004 ; Curatio 2004 ; Doupe 2004 ; GFATM 2004 ; Grace 2004 ; Brugha et al . 2005 ; Donoghue et al . 2005a ; ITPC 2005 ; Starling et al . 2005a ; Stillman and Bennett 2005 ; Kelly et al . 2006 ; Wilkinson et al . 2006 ). Often CCMs were too large and unwieldy, which detracted from efficient functioning (Doupe 2004 ; Grace 2004 ). Concerns emerged in 2004 about the degree of participation and the capacity of Mozambique's CCM to adapt to its new role in overseeing Principal Recipient activities, in that the two principal recipients of funding were bodies represented by the Chair and Vice-Chair of the CCM (Starling et al . 2005b ). Similar concerns were also reported in Uganda with regard to the CCM Chair influencing the selection of its own constituency as the principal recipient of funds (Donoghue et al . 2005b ). However, comparable evidence of the effects of the MAP and PEPFAR on planning processes is lacking, reflecting PEPFAR's lack of transparency; and because the World Bank has traditionally negotiated directly with government behind closed doors.

GHI requirements and feed-back have also had positive effects on planning capacity (McKinsey 2005 ). In Georgia and China, feedback on the country proposals enhanced their capacity to plan and anticipate future needs (Curatio 2004 ; van Kerkhoff and Szlezak 2006 ). In Angola, which had recently emerged from conflict and where the risk of HIV/AIDS transmission was increasing, Global Fund and World Bank support was seen as critical in identifying appropriate measures for control of the epidemic (McKinsey 2005 ).

Widening stakeholder involvement: engaging and funding civil society

All three GHIs, most visibly the Global Fund through its CCMs, have boosted stakeholder engagement. However, several negative early effects were reported, which stemmed partly from government responses to these new ways of working. In 2002–04, some governments were perceived to be controlling the Global Fund processes and marginalizing civil society (Brugha et al . 2004 ; Grace 2004 ). Several studies reported problems in CCM constituencies, such as reluctance by government-dominated CCMs to include strong non-governmental partners (including the private for-profit sector), strong advocates for communities living with AIDS, geographical representation and strong technical expertise (Curatio 2004 ; Doupe 2004 ; GFATM 2004 ; Brugha et al . 2005 ; Donoghue et al . 2005a ; ITPC 2005 ; Starling et al . 2005a ; Stillman and Bennett 2005 ; Kelly et al . 2006 ). As a result, the Global Fund introduced tighter conditions, stipulating that CCMs, which prepare proposals and apply for funds, must include these sectors (Wilkinson et al . 2006 ).

Despite early problems, GHIs have been more effective than other financing mechanisms in diversifying stakeholder participation and involving NGOs and faith-based organizations (FBOs), enabling them to gain direct access to financial resources (GFATM 2004 ; OED 2004 ; McKinsey 2005 ; Wilkinson et al . 2006 ). MAP has expanded the scope and range of FBO and community responses to the HIV epidemic (Gorgens-Albino et al . 2007 ; Oomman et al . 2007 ). However, little published evidence was found on how communities’ planning capacity was strengthened. PEPFAR's focus on civil society has been at the expense of building government capacity and through heavy use of US NGOs (Oomman et al . 2007 ). A follow-up survey in Benin showed that the Global Fund CCM had become more pro-active since the baseline survey by including a broader range of stakeholders (Gbangbadthore et al . 2006 ). In Malawi, Benin and Zambia, the new opportunities provided by the Global Fund strengthened public/private collaborations, through NGOs establishing umbrella organizations that helped to channel funds through principal recipients to sub-recipients (Donoghue et al . 2005a ; Mtonya et al . 2005 ; Smith et al . 2005 ; Stillman and Bennett 2005 ). This also served to improve the capacity of local district structures, local NGOs and community groups.

Widening stakeholder involvement: multiple funding channels

Several studies report that GHIs, which focus on the same diseases, channel funds through many different routes, both within and outside the public sector. While there are clear advantages to involving a greater diversity of actors, many countries have found it difficult to cope with the complexity. For example, in Angola MAP channelled funds through the Ministry of Planning rather than the Ministry of Health, which was the usual channel, and the Global Fund did so through the United Nations Development Programme, UNDP (McKinsey 2005 ). PEPFAR, on the other hand, has chosen to channel its funds outside the public sector, mainly through international (often US-based) NGOs. These NGOs then fund country-based civil society and faith-based groups (Oomman et al . 2007 ). There were concerns in South Africa, Uganda, Benin, Ethiopia and Malawi about the rapid growth of the NGO sector, where many new NGOs were seen as having limited capacity and were only weakly accountable (Donoghue et al . 2005b ; Bennett et al . 2006 ; Kelly et al . 2006 ). These studies concluded that too little attention was paid to strengthening community-level systems and to ensuring adequate regulation or quality control in the non-public sector. There has been minimal reported involvement of the private for-profit sector in GHI processes and in receipt of funds, apart from the Global Fund in Malawi where private clinics were allocated free antiretroviral drugs (Stillman and Bennett 2005 ).

Despite concerns about capacity, it has been accepted almost universally as a positive feature of the GHIs that they all have disbursed significant funds to civil society. The Global Fund mandated that 30% of all grants should be allocated to civil society groups (Wilkinson et al . 2006 ); and the SWEF and Tracking Studies reported early evidence that the Global Fund was achieving this objective (Banteyerga et al . 2005 ; Donohoe et al . 2005a ; Mtonya et al . 2005 ; Smith et al . 2005 ).

Disbursement, absorption and management of GHI funds: disbursement and absorptive capacity

From 2002 to 2007, countries reported that the combination of different fiscal years, the different disbursement mechanisms of the three GHIs and unpredictable disbursement had made it difficult for countries to draw down funds and integrate these resources into coordinated national plans (Brugha et al . 2004 ; Grace 2004 ; Stillman and Bennett 2005 ; McKinsey 2005 ; Wilkinson et al . 2006 ; Oomman et al . 2007 ). Tanzania experienced quite similar problems in drawing down MAP and later Global Fund money; and respondents commented on the lack of lesson-learning across GHIs (Starling et al . 2005a ). In the Global Fund Tracking Studies (2003–04) and baseline SWEF studies (2004–05), countries reported immense pressure due to the Global Fund's performance-based disbursement conditions (Brugha et al . 2004 ; Stillman and Bennett 2005 ). Such conditions were not seen as inherently wrong, but as compounding problems of low absorptive capacity due to weak country budgetary systems and incompatible donor systems (ITPC 2005 ; McKinsey 2005 ). In Ethiopia, weak government plans were seen as not providing a solid base for guiding Global Fund-supported activities (Banteyerga et al . 2005 ). In Laos, the Global Fund delayed disbursements until the country resolved its financial, monitoring and evaluation systems’ weaknesses (McKinsey 2005 ). Lack of a country presence (a key feature of the Global Fund), and the slowness of it and its global multilateral and bilateral partners to respond to the need for stronger technical support to countries, often delayed and impaired grant implementation (Wilkinson et al . 2006 ).

On the positive side, evidence has shown that over the years 2002–07, the three GHIs have significantly increased total aid flows in the areas of the focal diseases (Gorgens-Albino et al . 2007 ; Oomman et al . 2007 ; Sepulveda et al . 2007 ). GHIs have been achieving their objective of prioritizing and funding the control of major diseases that were previously under-resourced (McKinsey 2005 ). In Benin, the Global Fund raised the overall budget for health spending by about 15% (Gbangbadthore et al . 2006 ). In the early 2000s, MAP made large commitments to HIV and AIDS control in advance of other donors with US$1 billion being fully committed by 2004 (Gorgens-Albino et al . 2007 ). Since 2004, MAP funding has been more moderate, while the Global Fund and in particular PEPFAR have increased their funding dramatically, as reported for Mozambique, Uganda and Malawi (Oomman et al . 2007 ). PEPFAR has disbursed more quickly than the Global Fund and MAP, partly by working outside of and making little effort to build government systems, which have been slower to draw down funds than non-government recipients (Stillman and Bennett 2005 ; Oomman et al . 2007 ). However, PEPFAR has provided countries with the least flexibility in how funds could be used, whereas the Global Fund has been seen as willing to fund gaps (Oomman et al . 2007 ).

Disbursement, absorption and management of GHI funds: financial management

Several studies have reported GHI-imposed duplication and parallelism in financial and programmatic management systems and cycles, which have created fragmentation and increased the administrative burden for already overloaded staff (Brugha et al . 2004 ; Grace 2004 ; Brugha et al . 2005 ; McKinsey 2005 ; Stillman and Bennett 2005 ; Oomman et al . 2007 ). Although separate systems for financing were sometimes justified, GHIs differed in efforts to use existing systems and/or to improve the capacity of recipient organizations.

The stringent World Bank MAP requirements have often led to the establishment of new financial management systems rather than using standard government systems. However, the World Bank MAP projects have made progress in building reliable country systems for financial management. Specific project staff, who sit within government ministries, were hired to oversee grant implementation and to train government staff in MAP-specific procedures (Oomman et al . 2007 ). PEPFAR, in their function as an emergency response, required recipient organizations that were able to manage funding efficiently and implement fast. Often they have channelled funding outside of the government system, following PEPFAR-specific accounting and reporting procedures, while they relied on their recipient organizations to build the capacity of the government and other local organizations (Oomman et al . 2007 ). The Global Fund has continued to utilize an independent Local Fund Agent (LFA) financial management and audit model. However, evaluations of the LFA system reported that, in practice, LFAs have often not been well aligned with government systems. Frequently they have lacked programmatic skills and have been unable to mobilize and work in partnership with other country partners (Kruse and Claussen 2004 ; Euro Health Group 2007 ). Recently, the Global Fund has been aiming to strengthen its LFA system through providing more comprehensive tools and guidelines for recipient (and sub-recipient) organizations (Euro Health Group 2007 ). However, evaluations of GHIs across 2002–07 have reported little progress in reducing GHI systems’ duplications.

Monitoring and evaluation (M&E)

Parallel systems and processes established by new GHIs contravene the Paris Principles of Aid Effectiveness, often bypassing countries’ own systems, and result in avoidable transaction costs (McKinsey 2005 ). However, M&E requirements of GHIs have often not been streamlined and, as a result, it is generally reported in national studies that managers, at the national and district levels, have to prepare multiple M&E reports, in different formats and with different deadlines for the different donors of their programmes. In some cases, additional indicators have been required that were not part of countries’ own systems (McKinsey 2005 ).

PEPFAR, which operates outside government systems, has continued to use project approaches and expects reporting to be carried out according its formats (Oomman et al . 2007 ). Several studies reported contrasting perceptions of Global Fund alignment with existing country M&E systems (Brugha et al . 2005 ; Wilkinson et al . 2006 ). In Cambodia, Uganda and Cameroon, the use of Global Fund project-related monitoring tools undermined national programmes and the ‘Three Ones’ principle of a single M&E system.

The M&E emphasis of the first generation of the World Bank supported AIDS projects was on monitoring as opposed to evaluation, but was often poorly designed, under-implemented and under-supervised (OED 2005 ). Informants in Tanzania, Malawi, Uganda and Mozambique also expressed concern about weak local M&E capacity or weak systems for monitoring GHI funds and were sceptical of their countries’ ability to demonstrate that they had met agreed targets (Brugha et al . 2005 ). Consequently, GHIs were encountering weak M&E systems and putting in place GHI-specific measures to address these weaknesses.

Improvements over time have been reported in that GHIs have started to work with countries on developing and strengthening their M&E systems (McKinsey 2005 ). In Sri Lanka and Nigeria, Global Fund indicators fitted with the national programme indicators and national M&E activities (Wilkinson et al . 2006 ). The follow-up SWEF studies in Ethiopia and Malawi in 2005–06 reported some improvements in integration, alignment and performance assessment since the baseline studies, one year earlier (Stillman and Bennett 2005 ). Recently, the World Bank developed an operational guide for programme M&E and put in place M&E country assistance capacity in the form of the Global Monitoring and Evaluation Support Team (GAMET), based at the World Bank (Gorgens-Albino et al . 2007 ). Recent findings show that PEPFAR has been supporting building local capacity for collecting, synthesizing and reporting on HIV/AIDS data through skills training, development of health information systems, and technical assistance, although neglecting or avoiding the strengthening of national systems (Sepulveda et al . 2007 ).

Human resources for health: availability of health workers

Shortage of trained staff was reported in early country studies as a major barrier to health systems, and GHI efforts to scale-up antiretroviral treatment services in particular (Grace 2004 ; Brugha et al . 2005 ; Mtonya et al . 2005 ). In 2002–04 in Zambia, it was reported that sufficient numbers of health workers were not being trained to compensate for losses due to illness, death from AIDS, and emigration (Donoghue et al . 2005a ). Both Malawi and Kenya reported public sector health worker shortages, which key informants believed would be aggravated by selectively investing in health workers to work in GHI-funded programmes for control of focal diseases such as HIV/AIDS (World Bank 2004 ; Mtonya et al . 2005 ). Migration of personnel from reproductive health and family planning through re-allocation to ‘follow the money of the Global Fund’ was reported in 2005–06 (Schott et al . 2005 ; Gbangbadthore et al . 2006 ; Wilkinson et al . 2006 ). In Ethiopia, Global Fund supported activities were inducing health workers to move away from the public to the private sector, NGOs and bilateral agencies (Banteyerga et al . 2005 ). The follow-up component of the study suggested this had worsened (Banteyerga et al . 2006 ). The nature of human resource problems varied, with shifts of health workers from public to donor supported projects/programmes as well as to other countries, causing both internal and external ‘brain drain’ (Sepulveda et al . 2007 ). However, national key informants perceived that the broader donor community and GHIs acted similarly in initiating projects that poached qualified staff from routine government programmes and employment, by offering them incentives or higher salaries (Donoghue et al . 2005a ; Drew and Purvis 2006 ).

Over time, positive responses to (partly GHI-induced) health worker shortages were reported. The follow-up study in Ethiopia found that the government had put in place a human resource strategy, which included increases in salaries and incentives to keep health workers in the public sector (Banteyerga et al . 2006 ). PEPFAR has supported a number of activities focused on retention of health workers, providing physicians working in rural areas with better working and living conditions such as housing, transportation, hardship allowances and educational stipends for their children (Sepulveda et al . 2007 ). Malawi's Global Fund Round 5 proposal addressed health worker distribution through aiming to increase community-based services by recruiting, training and retaining Health Surveillance Assistants (HSAs) to assist in scaling up antiretrovirals (Mtonya et al . 2005 ). In Benin, the Global Fund was reported to have strengthened infrastructure and provided equipment that health workers needed to better perform their tasks (Gbangbadthore et al . 2006 ).

Human resources for health: workload, motivation and incentives

The combination of the additional workload, which GHI funding has facilitated, and restrictions on public health staffing levels and remuneration have increased the strain on public sector health workers. This has been further exacerbated when GHI-funded activities accelerated staff leakage to the private sector. In Benin, it was reported that workers already working in the public sector earned no additional pay despite the extra work due to the Global Fund. However, programmes that hired health workers directly with Global Fund money were receiving higher salaries (Smith et al . 2005 ). The 2003–04 studies in Zambia and Mozambique reported that the inability to use Global Fund support to supplement the salaries of government staff running HIV programmes—most funds were going to support programme activities and purchase commodities—was de-motivating staff (Donoghue et al . 2005a ; Starling et al . 2005b ). The early focus of PEPFAR was to strengthen the skills of existing health workers to provide HIV care and treatment services and, similar to the Global Fund, funding could not be used to top-up the salaries of existing public sector staff or to hire additional staff (Sepulveda et al . 2007 ). However, in Uganda, the salaries of staff hired by NGOs were supported by PEPAR funds, which enabled them to attract the best health workers from the public sector (Oomman et al . 2007 ). MAP funding could be used for salary top-ups but only at the district government level (Oomman et al . 2007 ).

The studies reviewed here (2002–07) showed little evidence that the early GHI-funded programmes had addressed issues of workload and motivation. Where there were pre-existing shortages of health workers, GHI-supported activities were overburdening already limited capacity. The evidence suggests that the Global Fund has changed its conditions over time. Mozambique's 2002 Round 2 request for salary support for scaling up the numbers of health workers to deliver its TB control programme was rejected by the Fund (Starling et al . 2005b ). In contrast, in Malawi a Round 1 Global Fund grant was re-allocated 3 years later in 2005 to increase all health worker salaries, at the request of the government and other donors (Stillman and Bennett 2005 ).

Human resources for health: training

Early studies of the Global Fund anticipated adverse effects as ministries of health were under pressure to spend large amounts of money quickly, for example on training workshops, and health workers were relying on per diem allowances to supplement salaries (GFATM 2004 ; Brugha et al . 2005 ; Stillman and Bennett 2005 ). Most training focused largely on improving clinical skills, while planning and managerial skills, critical to successful implementation, were often neglected (McKinsey 2005 ; Stillman and Bennett 2005 ; Drew and Purvis 2006 ). In Benin, there were early missed opportunities to use Global Fund money to develop generic and transferable skills, such as management, monitoring and evaluation (Smith 2005 ).

In general, the increase in funding for training has been reported as a positive effect of GHIs. The Global Fund has allowed recipients to determine their own needs in capacity building (Oomman et al . 2007 ). In Ethiopia, the Global Fund supported the scale up training of multiple cadres, such as nurses, health officers, laboratory technicians and health extension workers (Banteyerga et al . 2005 ). In Benin, some Global Fund training provided skills transferable to disease programmes beyond the three focal diseases (Smith et al . 2005 ). PEPFAR typically supported capacity-building activities focused on training of existing personnel as an approach to addressing the shortage in human resources (Sepulveda et al . 2007 ). For example, in Uganda it funded the training of teachers to implement revised school curricula on HIV/AIDS and technical assistance for the district AIDS committees to generate HIV/AIDS strategic plans for the districts (Oomman et al . 2007 ). Oomman et al . ( 2007 ) reports that PEPFAR plans for 2008 would focus on building local capacity and a substantial amount of targets are focused on training new health workers.

The capacity-building activities of the World Bank's MAP have focused on national government, civil society organizations, district government and in particular on the community level; and have generally been seen as positive (Oomman et al . 2007 ). They have concentrated on management, administration, finance and implementation skills, although most involved short-term training. MAP was the first donor to channel a substantial amount of funding to the community level and build local capacity. In Zambia, key informants were positive about the community-response component of the MAP project (Oomman et al . 2007 ). More research is needed to determine the effect of these GHI-funded activities on human resource capacity and retention at the service delivery level in recipient countries.

Interpreting the evidence

This study has reviewed the literature on the effects of three GHIs on country health systems with respect to: 1) national policy; 2) coordination and planning; 3) stakeholder involvement; 4) disbursement, absorptive capacity and management; 5) monitoring & evaluation; and 6) human resources. This section discusses the major strengths and limitations of the quality of available evidence which is of importance when interpreting the results.

The major strength and rationale for this paper is that it has taken a systematic approach to selecting and reviewing the evidence of the health systems effects of specific GHIs in what has become a politically-charged arena. A recent review by Yu et al . ( 2008 ), on the effects on health systems of HIV/AIDS funding more generally, has cited press releases and GHI assertions, as well as commissioned evaluations, when attributing effects to GHI funding. Studies that look more broadly at the effects of increased funding to HIV/AIDS control are also less likely to shed light on the specific health systems effects and the particular strengths and weaknesses of different GHIs. The chapter by Brugha ( 2008 ) was not a systematic review and aimed to draw out the policy processes involved and policy lessons learned since the emergence of GHIs, rather than to review their effects on health systems. The framework that has been applied here is derived from early country experiences in managing GHIs, experiences that are not adequately captured in WHO's health systems building blocks frameworks (WHO 2007 ). The review provides an historical backdrop to forthcoming district-level studies; but also points to some chronic, refractory problems at the national level, which are inherent in the incentive systems underlying disease-specific initiatives.

Despite our systematic approach, the available evidence in this review has several limitations. First, most studies have focused on the national level, where GHI effects are initially felt. There was little empirical evidence (and much conjecture) regarding their effects at the district, facility and community levels. It is here that the strengths, weaknesses and added value (or not) of these still new, disease-specific initiatives will play out and will need to be assessed.

Secondly, with a few exceptions, most were descriptive studies with a cross-sectional design, which limits their capacity to demonstrate changes over time. GHIs have evolved and have sometimes been quite adept in learning and applying lessons, which has been more evident with the Global Fund than with PEPFAR. Rapid lesson-learning has meant that some study findings quickly become outdated or new problems supersede old ones.

Thirdly, not all GHIs and regions of the world have been studied equally. The Global Fund, because of its visibility and transparency, has been evaluated most often, whereas PEPFAR has remained the most opaque of these GHIs. Moreover, the limited empirical evidence on MAP, Global Fund and PEPFAR country-level effects relied heavily on evaluations conducted or commissioned by—or on behalf of—these initiatives, which may affect their validity. Most evidence is also based on studies conducted in sub-Saharan Africa, which is naturally the priority region for three HIV/AIDS-focused GHIs.

Lastly, mainly because this review relied heavily on unpublished reports (‘grey literature’), appraisal of the quality of data collection and interpretation was hampered by limited information on methods, quality control and analysis. Furthermore, the lack of consensus on appropriate criteria for assessing qualitative research (Dixon-Woods et al . 2004 ; Goldsmith et al . 2007 ) precluded us from making formal judgements on the quality of the studies.

This review has contributed to the surprisingly thin body of evidence regarding the health systems effects of three major GHIs. The systematic approach adopted has produced a series of findings that are of relevance to the current international debate on this issue. Based on the findings presented above, conclusions and recommendations are proposed that are relevant to national and international policy makers, donors, researchers and indeed civil society organizations.

Overall, the findings of this review of studies published between 2002 and 2007 suggest that the three GHIs initially often had negative effects, and later—as they learned lessons—more often positive effects on health systems. They also had different effects. From its outset, MAP was viewed positively for its capacity-building activities at national and district public-sector levels, and particularly at the community level. The Global Fund's particular strength has been in boosting the engagement of NGOs and faith-based bodies, bringing them into planning structures with government and enabling them to access significant funds. PEPFAR is well regarded for its fast and predictable disbursement of funding to civil society implementers.

At the level of national policy development , GHIs have generally made most progress in aligning with national joint strategic planning processes, while harmonization of activities with other partners has remained a challenge. Effects on other national health priorities, such as family planning and maternal care, were not reported and will require district and facility studies to assess effects at the service delivery level. While the Global Fund supported, with variable success, programmes that reflected local priorities and country ownership, PEPFAR's rigid budget allocations were more difficult to fit to a country's own priorities for health.

MAP's support to a multisectoral response has been most hindered by the weak capacity and lack of intersectorality of recipient country ministries, which supports the hypothesis that GHIs reveal rather than cause country systems weaknesses. Indeed, GHIs did not initially consider health systems strengthening to be part of their mandate but are now more willing to address systems weaknesses (Brugha et al . 2005 ; McKinsey 2005 ). This is all the more important now because, due to the rapid GHI-supported scaling up of HIV care and treatment in low income countries, HIV and AIDS are being transformed from an epidemic emergency to an endemic manageable chronic disease . As such, HIV control will require health systems that support continuity of care and the retention and follow up of patients with multiple and multi-systems diseases (El-Sadr and Abrams 2007 ).

Despite some positive developments, such as the integration of Global Fund support into some countries’ SWAps, donor harmonization activities have continued to fall short. While the vertical funding, planning and performance monitoring approaches that have characterized the GHIs could be seen as more efficient responses to tackling disease emergencies, these approaches created substantial barriers to harmonizing donor activities. They also reflected GHIs’ inherent need to demonstrate value for money through donor-specific measurements of performance. More recently, the GHIs have retreated from making claims of initiative-specific attributable successes (Brugha 2007 ; Gorgens-Albino et al . 2007 ), acknowledging the interplay of the many inputs and factors affecting programme implementation and service delivery. This was probably in response to the inherent difficulties of attribution in the complex multi-funded terrain of African health systems (Bennett et al . 2006 ). It also reflected a change in the global development assistance climate in the light of the Paris Declaration on Aid Effectiveness (OECD 2005 ).

However, it is at the national policy implementation level where the main early effects of GHIs—often negative at first and subsequently positive—have been encountered and documented. GHIs have led to multiple and parallel coordinating bodies , such as Global Fund CCMs, that have conflicted and sometimes contested with pre-existing bodies such as National AIDS Councils. Often, neither was providing the necessary leadership and oversight. Others, such as PEPFAR, established and continued to use parallel planning processes, inevitably pulling governments and other implementers away from other important activities because of the volume of funds at stake. However, positive effects have followed negative ones in that CCMs have enabled substantial improvements in stakeholder participation in the health sector. Through all three GHIs, NGOs and faith-based organizations have become direct recipients of significant levels of funding and thereby additional programme implementers. While there are great advantages to involving a greater diversity of actors, these new sources of funds have provoked real tensions in resource-starved settings between governments, as the traditional recipients of donor aid, and new civil society implementing organizations. Emerging evidence suggests that GHIs, which have been either geographically or ideologically detached from these concerns, have not done enough to help manage these tensions.

Where GHIs have been most retrograde has been in maintaining their own fiscal cycles, systems for auditing expenditure and GHI-specific reporting requirements. There have been gradual efforts to reduce transaction costs for countries. For example, the Global Fund has shown a willingness (in principle, at least) to adapt and align with country systems and directly fund countries’ national disease control plans, for example through ‘rolling continuation channels’ (GFATM 2007 ). However, it has continued to utilize a non-aligned Local Fund Agent model for financial management and audit (GFATM 2008b ). More recently, GHIs have started to work with countries in strengthening monitoring and evaluation systems and increasing local capacity, although this has mainly been for HIV/AIDS programmes and strengthening of the wider national health system has been neglected.

Finally, the effective implementation of GHI-supported programmes depends on human resources , which are recognized as the main bottleneck to scaling-up service delivery, especially in sub-Saharan Africa. There were credible, if anecdotal, early reports that different funding sources were competing for a limited pool of health workers by offering them incentives or higher salaries, which accelerated public sector staff leakage to non-government sectors. The combination of additional workload and remuneration constraints led to de-motivated and overburdened health workers in the public sector. One of the reasons was that GHI requirements in the early years, except to some extent MAP, precluded the funding of salaries for additional public sector health workers. Countries have also invested heavily in writing funding applications, whereas capacity for implementation of GHI-funded programmes has often been lacking. The early studies reviewed here suggest that the Global Fund and PEPFAR limited their human capacity-building activities to training existing health care workers, while MAP undertook a wider approach to capacity building at national and community levels. However, again, emerging evidence suggests that GHIs have been increasingly recognizing the importance of focusing attention on (and funding for) training and improving work and living conditions of health workers in rural areas as retention strategies.

The principal recommendation to GHIs, recipient donor countries, civil society organizations and technical agencies alike is to engage more fully with the Paris Principles for Aid Effectiveness as an important step in maximizing positive and minimizing negative effects of their programmes: Secondly, country and global policy makers and donors should demand and fund the acquisition of better evidence on what is a complex and rapidly evolving arena. What is now needed are coordinated evaluations using multiple methods in order to assess and understand the combined effects of GHIs and how they work alongside longer-standing disease-control financing mechanisms. Given the rapid learning of GHIs, which is often but not always applied, continuous monitoring and independent evaluations are needed to track changes and identify refractory problems. Early evaluations have been generally descriptive, necessary because of the rapid evolution in the GHI arena. Now, more analytical health policy and health systems evaluations are needed.

GHIs, which have signed up to these principles, could do much more to promote country ownership through aligning their objectives with comprehensive national health (rather than only HIV/AIDS) priorities.

Coordinated GHI investment to strengthen the capacity of national systems for financial management, M&E and reporting could thereby give GHIs the confidence to harmonize, align and use these systems.

There is an obvious need for stronger coordination of donor investments to support countries’ national strategic health plans, which can include flexibility to allow GHIs and other donors to support specific components of such plans.

GHIs should give recipient countries sufficient flexibility to address systems’ weaknesses and strengthen implementation capacity, especially in human resources at all levels.

Public sector health worker shortages, recognized as the key determinant for wide-ranging efforts to scale-up health-related priority interventions, should be addressed by GHIs through providing long-term funding for additional human resources for the health sector.

GHIs should continue to encourage the participation of non-government as well as government stakeholders, while reducing tensions created by funding new implementers in service delivery by requiring them, as far as possible, to utilize and contribute data to national information systems.

We believe this review of evidence on the early national effects of GHIs is timely, in advance of dissemination of findings in 2009 from the Global Fund Five Year Evaluation ( http://www.theglobalfund.org/en/about/terg/five_year_evaluation/ ), the Global HIV/AIDS Initiatives Network (GHIN – http://www.ghinet.org ) 3 and the recent WHO-launched initiative ‘Maximising Positive Synergies between health systems and GHIs’ (WHO 2008 ). Syntheses and interpretation of findings from these different evaluations—on a country-by-country basis—could provide invaluable lessons on how a much more complex mix of funding for disease control and health systems strengthening can work together in a complementary way to support country-led efforts to roll back the HIV and AIDS epidemic. They could also provide lessons for the establishment of effective long-term, comprehensive monitoring and evaluation systems.

Regien Biesma was funded under a 4-year research project grant, ‘GHIs in Africa’ (INCO-CT-2006-032371), funded by the EU 6th framework INCO-DEV programme. The INCO partners are based in three southern African countries (Angola, Mozambique and South Africa) and three European countries (Belgium, Ireland and Portugal). The authors would like to thank all partners who provided helpful comments on an earlier review of global health initiatives. Neil Spicer is funded under a grant from the Open Society Institute (OSI). Aisling Walsh is funded under the Global HIV/AIDS Initiatives Network (GHIN) grant, funded by Irish Aid and DANIDA. Ruairí Brugha and Gill Walt are co-coordinators of the GHIN network. Andrew Harmer was funded under a UK Department for International Development (DFID) grant to design a database on global health initiatives.

 The authors acknowledge with appreciation financial support from the Open Society Institute to undertake research on global HIV/AIDS initiatives and their effects on health systems.

MAP was small relative to the total annual amounts provided by the Global Fund and PEPFAR, which had become the major external funder of HIV/AIDS control in sub-Saharan Africa by 2007 (Oomman et al . 2007 ). However, MAP was the first of these new GHIs for funding HIV/AIDS control, whose impact on countries’ health systems was experienced and reported across 2002–07.

Our initial review used the following Boolean string: (global health initiatives OR global health partnership OR public-private partnership OR Global Fund OR PEPFAR OR World Bank MAP) AND (HIV/AIDS) AND (effects OR national policy OR financial flow OR public-private partnerships OR planning and coordination OR implementation and monitoring and evaluation OR human resources).

The Global HIV/AIDS Initiatives Network (GHIN) is examining the effects and the inter-relationships of the three global health initiatives. GHIN has its origins in the Global Fund Tracking Study (2003–04), and in the SWEF studies (2005–06), which together provided several of the studies and papers reviewed.

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What is global health? Key concepts and clarification of misperceptions

Xinguang chen.

1 Global Health Institute, Wuhan University, Wuhan, China

2 Department of Epidemiology, University of Florida, Florida, USA

3 School of Health Sciences, Wuhan University, Wuhan, China

Don Eliseo Lucero-Prisno, III

4 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK

Abu S. Abdullah

5 Global Health Research Center, Duke Kunshan University, Kunshan, China

6 Duke Global Health Institute, Duke University, Durham, North Carolina USA

Jiayan Huang

7 School of Public Health, Fudan University, Shanghai, China

Charlotte Laurence

8 Consultant in Global Health, London, UK

Xiaohui Liang

9 School of Public Health, Guangxi Medical University, Guangxi, China

10 Global Health Research Center, Dalian Medical University, Dalian, China

Shaolong Wu

11 School of Public Health, Sun Yat-sen University, Guangzhou, China

Peigang Wang

Tingting wang, yuliang zou.

The call for “W orking Together to Build a Community of Shared Future for Mankind” requires us to improve people’s health across the globe, while global health development entails a satisfactory answer to a fundamental question: “What is global health?” To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word “global” in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of “international health” by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.

“Promoting Health For All” can be considered as the mission of global health for collective efforts to build “a Community of Shared Future for Mankind” first proposed by President Xi Jinping of China in 2013. The concept of global health continues to evolve along with the rapid development in global health research, education, policymaking, and practice. It has been promoted on various platforms for exchange, including conferences, workshops and academic journals. Within the Editorial Board of Global Health Research and Policy (GHRP), many members expressed their own points of view and often disagreed with each other with regard to the concept of global health. Substantial discrepancies in the definition of global health will not only affect the daily work of the Editorial Board of GHRP, but also impede the development of global health sciences.

To promote a better understanding of the term “ global health” , we convened a special session in the 2019 GHRP Editorial Board Meeting on the 7th of July at Wuhan University, China. The session started with a review of previous work on the concept of global health by researchers from different institutions across the globe, followed by free brainstorms, questions-answers and open discussion. Individual participants raised many questions and generously shared their thoughts and understanding of the term global health. The session was ended with a summary co-led by Dr. Xinguang Chen and Dr. Hao Li. Post-meeting efforts were thus organized to further synthesize the opinions and comments gathered during the meeting and post-meeting development through emails, telephone calls and in-person communications. With all these efforts together, concensus have been met on several key concepts and a number of confusions have been clarified regarding global health. In this editorial, we report the main results and conclusions.

A brief history

Our current understanding of the concept of global health is based on information in the literature in the past seven to eight decades. Global health as a scientific term first appeared in the literature in the 1940s [ 1 ]. It was subsequently used by the World Health Organization (WHO) as guidance and theoretical foundation [ 2 – 4 ]. Few scholars discussed the concept of global health until the 1990s, and the number of papers on this topic has risen rapidly in the subsequent decade [ 5 ] when global health was promoted under the Global Health Initiative - a global health plan signed by the U.S. President Barack Obama [ 6 ]. As a key part of the national strategy in economic globalization, security and international policies, global health in the United States has promoted collaborations across countries to deal with challenging medical and health issues through federal funding, development aids, capacity building, education, scientific research, policymaking and implementation.

Based on his experience working with Professor Zongfu Mao, the lead Editors-in-Chief, who established the Global Health Institute at Wuhan University in 2011 and launched the GHRP in 2016, Dr. Chen presented his own thoughts surrounding the definition of global health to the 2019 GHRP Editorial Board Meeting. Briefly, Dr. Chen defined global health with a three-dimensional perspective.

First, global health can be considered as a guiding principle, a branch of health sciences, and a specialized discipline within the broader arena of public health and medicine [ 5 ]. As many researchers posit, global health first serves as a guiding principle for people who would like to contribute to the health of all people across the globe [ 5 , 7 , 8 ].

Second, Dr. Chen’s conceptualization of global health is consistent with the opinions of many other scholars. Global health as a branch of sciences focuses primarily on the medical and health issues with global impact or can be effectively addressed through global solutions [ 9 – 16 ]. Therefore, the goal of global health science is to understand global medical and health issues and develop global solutions and implications [ 7 , 9 , 15 , 17 – 19 ].

Third, according to Dr. Chen, to develop global health as a branch of science in the fields of public health and medicine, a specialized discipline must be established, including educational institutions, research entities, and academic societies. Only with such infrastructure, can the professionals and students in the global health field receive academic training, conduct global health research, exchange and disseminate research findings, and promote global health practices [ 5 , 15 , 20 – 23 ].

Developmentally and historically, we have learned and will continue to learn global health from the WHO [ 1 , 4 , 24 , 25 ]. WHO’s projects are often ambitious, involving multiple countries, or even global in scope. Through research and action projects, the WHO has established a solid knowledge base, relevant theories, models, methodologies, valuable data, and lots of experiences that can be directly used in developing global health [ 26 – 29 ]. Typical examples include WHO’s efforts for global HIV/AIDS control [ 13 , 30 – 32 ], and the Primary Healthcare Programs to promote Health For All [ 33 , 34 ].

The definition of Global Health

From published studies in the international literature and our experiences in research, training, teaching and practice, our meeting reached a consensus-global health is a newly established branch of health sciences, growing out from medicine, public health and international health, with much input from the WHO. What makes global health different from them is that (1) global health deals with only medical and health issues with global impact [ 35 , 5 , 36 , 10 , 14 , 2 ] the main task of global health is to seek for global solutions to the issues with global health impact [ 7 , 18 , 37 ]; and (3) the ultimate goal is to use the power of academic research and science to promote health for all, and to improve health equity and reduce health disparities [ 7 , 14 , 15 , 18 , 38 ]. Therefore, global health targets populations in all countries and involves all sectors beyond medical and health systems, although global health research and practice can be conducted locally [ 39 ].

As a branch of medical and health sciences, global health has three fundamental tasks: (1) to master the spatio-temporal patterns of a medical and/or health issue across the globe to gain a better understanding of the issue and to assess its global impact [ 40 – 43 ]; (2) to investigate the determinants and influential factors associated with medical and health issues that are known to have global impact [ 15 , 40 – 43 ]; and (3) to establish evidence-based global solutions, including strategies, frameworks, governances, policies, regulations and laws [ 14 , 15 , 28 , 38 , 44 – 47 ].

Like public health, medicine, and other branches of sciences, global health should have three basic functions : The first function is to generate new knowledge and theories about global health issues, influential factors, and develop global solutions. The second function is to distribute the knowledge through education, training, publication and other forms of knowledge sharing. The last function is to apply the global health knowledge, theories, and intervention strategies in practice to solve global health problems.

Understanding the word “global”

Confusion in understanding the term ‘global health’ has largely resulted from our understanding of the word “global”. There are few discrepancies when the word ‘global’ is used in other settings such as in geography. In there, the world global physically pertains to the Earth we live on, including all people and all countries in the world. However, discrepancies appear when the word “global” is combined with the word “health” to form the term “global health”. Following the word “global” literately, an institution, a research project, or an article can be considered as global only if it encompasses all people and all countries in the world. If we follow this understanding, few of the work we are doing now belong to global health; even the work by WHO are for member countries only, not for all people and all countries in the world. But most studies published in various global health journals, including those in our GHRP, are conducted at a local or international level. How could this global health happen?

The argument presented above leads to another conceptualization: Global health means health for a very large group of people in a very large geographic area such as the Western Pacific, Africa, Asia, Europe, and Latin America. Along with this line of understanding, an institution, a research project or an article involving multi-countries and places can be considered as global, including those conducted in countries involved in China’s Belt and Road Initiative (BRI) [ 26 , 48 – 51 ]. They are considered as global because they meet our definitions of global health which focus on medical and health issues with global impact or look for global solutions to a medical or health issue [ 5 , 7 , 22 ].

One step further, the word ‘global’ can be considered as a concept of goal-setting in global health. Typical examples of this understanding are the goals established for a global health institution, for faculty specialized in global health, and for students who major or minor in global health. Although few of the global health institutions, scholars and students have conducted or are going to conduct research studies with a global sample or delivered interventions to all people in all countries, all of them share a common goal: Preventing diseases and promoting health for all people in the world. For example, preventing HIV transmission within Wuhan would not necessarily be a global health project; but the same project can be considered as global if it is guided by a global perspective, analyzed with methods with global link such as phylogenetic analysis [ 52 , 53 ], and the goal is to contribute to global implications to end HIV/AIDS epidemic.

The concept of global impact

Global impact is a key concept for global health. Different from other public health and medical disciplines, global health can address any issue that has a global impact on the health of human kind, including health system problems that have already affected or will affect a large number of people or countries across the globe. Three illustrative examples are (1) the SARS epidemic that occurred in several areas in Hong Kong could spread globally in a short period [ 11 ] to cause many medical and public health challenges [ 54 , 55 ]; (2) the global epidemic of HIV/AIDS [ 13 ]; and the novel coronavirus epidemic first broke out in December 2019 in Wuhan and quickly spread to many countries in the world [ 56 ].

Along with rapid and unevenly paced globalization, economic growth, and technological development, more and more medical and health issues with global impact emerge. Typical examples include growing health disparities, migration-related medical and health issues, issues related to internet abuse, the spread of sedentary lifestyles and lack of physical activity, obesity, increasing rates of substance abuse, depression, suicide and many other emerging mental health issues, and so on [ 10 , 23 , 36 , 42 , 57 – 60 ]. GHRP is expecting to receive and publish more studies targeting these issues guided by a global health perspective and supports more researchers to look for global solutions to these issues.

The concept of global solution

Another concept parallel to global impact is global solution . What do we mean by global solutions? Different from the conventional understanding in public health and medicine, global health selectively targets issues with global impact. Such issues often can only be effectively solved at the macro level through cross-cultural, international, and/or even global collaboration and cooperation among different entities and stakeholders. Furthermore, as long as the problem is solved, it will benefit a large number of population. We term this type of interventions as a global solution. For example, the 90–90-90 strategy promoted by the WHO is a global solution to end the HIV/AIDS epidemic [ 61 , 62 ]; the measures used to end the SARS epidemic is a global solution [ 11 ]; and the ongoing measures to control influenza [ 63 , 64 ] and malaria [ 45 , 65 ], and the measures taken by China, WHO and many countries in the world to control the new coronaviral epidemic started in China are also great examples of global solutions [ 66 ].

Global solutions are also needed for many emerging health problems, including cardiovascular diseases, sedentary lifestyle, obesity, internet abuse, drug abuse, tobacco smoking, suicide, and other problems [ 29 , 44 ]. As described earlier, global solutions are not often a medical intervention or a procedure for individual patients but frameworks, policies, strategies, laws and regulations. Using social media to deliver interventions represents a promising approach in establishment of global solutions, given its power to penetrate physical barriers and can reach a large body of audience quickly.

Types of Global Health researches

One challenge to GHRP editors (and authors alike) is how to judge whether a research study is global? Based on the new definition of global health we proposed as described above, two types of studies are considered as global and will receive further reviews for publication consideration. Type I includes projects or studies that involve multiple countries with diverse backgrounds or cover a large diverse populations residing in a broad geographical area. Type II includes projects or studies guided by a global perspective, although they may use data from a local population or a local territory. Relative to Type I, we anticipate more Type II project and studies in the field of global health. Type I study is easy to assess, but caution is needed to assess if a project or a study is Type II. Therefore, we propose the following three points for consideration: (1) if the targeted issues are of global health impact, (2) if the research is attempted to understand an issue with a global perspective, and (3) if the research purpose is to seek for a global solution.

An illustrative example of Type I studies is the epidemic and control of SARS in Hong Kong [ 11 , 67 ]. Although started locally, SARS presents a global threat; while controlling the epidemic requires international and global collaboration, including measures to confine the infected and measures to block the transmission paths and measures to protect vulnerable populations, not simply the provisions of vaccines and medicines. HIV/AIDS presents another example of Type I project. The impact of HIV/AIDS is global. Any HIV/AIDS studies regardless of their scope will be global as long as it contributes to the global efforts to end the HIV/AIDS epidemic by 2030 [ 61 , 62 ]. Lastly, an investigation of cardiovascular diseases (CVD) in a country, in Nepal for example, can be considered as global if the study is framed from a global perspective [ 44 ].

The discussion presented above suggests that in addition to scope, the purpose of a project or study can determine if it is global. A pharmaceutical company can target all people in the world to develop a new drug. The research would be considered as global if the purpose is to improve the medical and health conditions of the global population. However, it would not be considered as global if the purpose is purely to pursue profit. A research study on a medical or health problem among rural-to-urban migrants in China [ 57 , 58 , 60 ] can be considered as global if the researchers frame the study with a global perspective and include an objective to inform other countries in the world to deal with the same or similar issues.

Think globally and act locally

The catchphrase “think globally and act locally” presents another guiding principle for global health and can be used to help determine whether a medical or public health research project or a study is global. First, thinking globally and acting locally means to learn from each other in understanding and solving local health problems with the broadest perspective possible. Taking traffic accidents as an example, traffic accidents increase rapidly in many countries undergoing rapid economic growth [ 68 , 69 ]. There are two approaches to the problem: (1) locally focused approach: conducting research studies locally to identify influential factors and to seek for solutions based on local research findings; or (2) a globally focused approach: conducting the same research with a global perspective by learning from other countries with successful solutions to issues related traffic accidents [ 70 ].

Second, thinking globally and acting locally means adopting solutions that haven been proven effective in other comparable settings. It may greatly increase the efficiency to solve many global health issues if we approach these issues with a globally focused perspective. For example, vector-borne diseases are very prevalent among people living in many countries in Africa and Latin America, such as malaria, dengue, and chikungunya [ 45 , 71 , 72 ]. We would be able to control these epidemics by directly adopting the successful strategy of massive use of bed nets that has been proven to be effective and cost-saving [ 73 ]. Unfortunately, this strategy is included only as “simple alternative measures” in the so-called global vector-borne disease control in these countries, while most resources are channeled towards more advanced technologies and vaccinations [ 16 , 19 , 74 ].

Third, thinking globally and acting locally means learning from each other at different levels. At the individual level, people in high income countries can learn from those in low- and mid-income countries (LMICs) to be physically more active, such as playing Taiji, Yoga, etc.; while people in LMICs can learn from those in high income countries to improve their hygiene, life styles, personal health management, etc. At the population level, communities, organizations, governments, and countries can learn from each other in understanding their own medical and health problems and healthcare systems, and to seek solutions for these problems. For example, China can learn from the United States to deal with health issues of rural to urban migrants [ 75 ]; and the United States can learn from China to build three-tier health care systems to deliver primary care and prevention measures to improve health equality.

Lastly, thinking globally and acting locally means opportunities to conduct global health research and to be able to exchange research findings and experiences across the globe; even without traveling to another country. For example, international immigrants and international students present a unique opportunity for global health research in a local city [ 5 , 76 ]. To be global, literature search and review remains the most important approach for us to learn from each other besides conducting collaborative work with the like-minded researchers across countries; rapid development in big data and machine learning provide another powerful approach for global health research. Institutions and programs for global health provides a formal venue for such learning and exchange opportunities.

Reframing a local research study as global

The purpose of this article is to promote global health through research and publication. Anyone who reads this paper up to this point might already be able to have a clear idea on how to reframe his/her own research project or article to be of global nature. There is no doubt that a research project is global if it involves multiple countries with investigators of diverse backgrounds from different countries. However, if a research project targets a local population with investigators from only one or two local institutions, can such project be considered as global?

Our answer to this question is “yes” even if a research study is conducted locally, if the researcher (1) can demonstrate that the issue to be studied or being studied has a global impact, or (2) eventually looks for a global solution although supported with local data. For example, the study of increased traffic accidents in a city in Pakistan can be considered as global if the researchers frame the problem from a global perspective and/or adopt global solutions by learning from other countries. On the other hand, a statistical report of traffic accidents or an epidemiological investigation of factors related to the traffic accidents at the local level will not be considered as global. Studies conducted in a local hospital on drug resistance to antibiotics and associated cost are global if expected findings can inform other countries to prevent abuse of antibiotics [ 77 ]. Lastly, studies supported by international health programs can be packaged as global simply by broadening the vision from international to global.

Is Global Health a new bottle with old wine?

Another challenge question many scholars often ask is: “What new things can global health bring to public health and medicine?” The essence of this question is whether global health is simply a collection of existing medical and health problems packaged with a new title? From our previous discussion, many readers may already have their own answer to this question that this is not true. However, we would like to emphasize a few points. First, global health is not equal to public health, medicine or both, but a newly emerged sub-discipline within the public health-medicine arena. Global health is not for all medical and health problems but for the problems with global impact and with the purpose of seeking global solutions. In other words, global health focuses primarily on mega medical and health problems that transcend geographical, cultural, and national boundaries and seeks broad solutions, including frameworks, partnerships and cooperation, policies, laws and regulations that can be implemented through governments, social media, communities, and other large and broad reaching mechanisms.

Second, global health needs many visions, methods, strategies, approaches, and frameworks that are not conventionally used in public health and medicine [ 5 , 18 , 22 , 34 ]. They will enable global health researchers to locate and investigate those medical and health issues with global impact, gain new knowledge about them, develop new strategies to solve them, and train health workers to deliver the developed strategies. Consequently, geography, history, culture, sociology, governance, and laws that are optional for medicine and public health are essential for global health. Lastly, it is fundamental to have a global perspective for anyone in global health, but this could be optional for other medical and health scientists [ 40 , 41 ].

Global Health, international health, and public health

As previously discussed, global health has been linked to several other related disciplines, particularly public health, international health, and medicine [ 3 , 5 , 7 , 18 , 22 ]. To our understanding, global health can be considered as an application of medical and public health sciences together with other disciplines (1) in tackling those issues with global impact and (2) in the effort to seek global solutions. Thus, global health treats public health sciences and medicine as their foundations, and will selectively use theories, knowledge, techniques, therapeutics and prevention measures from public health, medicine, and other disciplines to understand and solve global health problems.

There are also clear boundaries between global health, public health and medicine with regard to the target population. Medicine targets patient populations, public health targets health populations in general, while global health targets the global population. We have to admit that there are obvious overlaps between global health, public health and medicine, particularly between global health and international health. It is worth noting that global health can be considered as an extension of international health with regard to the scope and purposes. International health focuses on the health of participating countries with intention to affect non-participating countries, while global health directly states that its goal is to promote health and prevent and treat diseases for all people in all countries across the globe. Thus, global health can be considered as developed from, and eventually replace international health.

Challenges and opportunities for China to contribute to Global Health

To pursue A Community with a Shared Future for Mankind , China’s BRI , currently involving more than 150 countries across the globe, creates a great opportunity for Chinese scholars to contribute to global health. China has a lot to learn from other countries in advancing its medical and health technologies and to optimize its own healthcare system, and to reduce health disparities among the 56 ethnic groups of its people. China can also gain knowledge from other countries to construct healthy lifestyles and avoid unhealthy behaviors as Chinese people become more affluent. Adequate materials and money may be able to promote physical health in China; but it will be challenging for Chinese people to avoid mental health problems currently highly prevalent in many rich and developed countries.

To develop global health, we cannot ignore the opportunities along with the BRI for Chinese scholars to share China’s lessons and successful experience with other countries. China has made a lot of achievements in public health and medicine before and after the Open Door Policy [ 49 , 78 ]. Typical examples include the ups and downs of the 3-Tier Healthcare Systems, the Policy of Prevention First, and the Policy of Putting Rural Health as the Priority, the Massive Patriotic Hygiene Movement with emphasis on simple technology and broad community participation, the Free Healthcare System for urban and the Cooperative Healthcare System for rural residents. There are many aspects of these initiatives that other countries can emulate including the implementation of public health programs covering a huge population base unprecedented in many other countries.

There are challenges for Chinese scholars to share China’s experiences with others as encountered in practice. First of all, China is politically very stable while many other countries have to change their national leadership periodically. Changes in leadership may result in changes in the delivery of evidence- based intervention programs/projects, although the changes may not be evidence-based but politically oriented. For example, the 3-Tier Healthcare System that worked in China [ 79 , 80 ] may not work in other countries and places without modifications to suit for the settings where there is a lack of local organizational systems. Culturally, promotion of common values among the public is unique in China, thus interventions that are effective among Chinese population may not work in countries and places where individualism dominates. For example, vaccination program as a global solution against infectious diseases showed great success in China, but not in the United States as indicated by the 2019 measles outbreak [ 81 ].

China can also learn from countries and international agencies such as the United Kingdom, the United States, the World Health Organization, and the United Nations to successfully and effectively provide assistance to LMICs. As China develops, it will increasingly take on the role of a donor country. Therefore, it is important for Chinese scholars to learn from all countries in the world and to work together for a Community of Shared Future for Mankind during the great course to develop global health.

Promotion of global health is an essential part of the Working Together  to Build a Community of Shared Future for Mankind. In this editorial, we summarized our discussions in the 2019 GHRP Editorial Board Meeting regarding the concept of global health. The goal is to enhance consensus among the board members as well as researchers, practitioners, educators and students in the global health community. We welcome comments, suggestions and critiques that may help further our understanding of the concept. We would like to keep the concept of global health open and let it evolve along with our research, teaching, policy and practice in global health.

Acknowledgements

We would like to thank those who had provided their comments for the improvement of the manuscript.

Authors’ contributions

Chen XG wrote the manuscript. LI H organized the meeting, collecting the comments and editing the manuscript. Lucero-Prisno DE integrated all the comments together. Abdullah AS, Huang JY, Laurence C, Liang XH, Ma ZY, Ren R, Wu SL, Wang N, Wang PG and Wang Tt all participated in the discussion and comments of this manuscript. Laurence C and Liang XH both provided language editing. The author(s) read and approved the final manuscript

The work is funded by the journal development funds of Wuhan University.

Ethics approval and consent to participate

Not applicable.

Consent for publication

The manuscript was sent to all the authors and they all agreed to submit it for publication.

Competing interests

The authors declare that they have no competing interests.

Contributor Information

Xinguang Chen, Email: [email protected] .

Hao Li, Email: [email protected] .

Don Eliseo Lucero-Prisno, III, Email: [email protected] .

Abu S. Abdullah, Email: [email protected] .

Jiayan Huang, Email: nc.ude.umhs@gnauhyj .

Charlotte Laurence, Email: moc.tenretnitb@1ecnerualc .

Xiaohui Liang, Email: nc.ude.uhw@gnailhx .

Zhenyu Ma, Email: [email protected] .

Zongfu Mao, Email: moc.621@oamfz .

Ran Ren, Email: moc.361@99narner .

Shaolong Wu, Email: nc.ude.usys.liam@gnolhsuw .

Nan Wang, Email: moc.361@6111hsirehc .

Peigang Wang, Email: moc.361@629gpw .

Tingting Wang, Email: moc.qq@8007170781 .

Hong Yan, Email: moc.nuyila@rxjmhnay .

Yuliang Zou, Email: moc.361@tkuoz .

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Prince Harry and Matt Damon set to address this year's Clinton Global Initiative annual meeting

Prince Harry, actor Matt Damon, and World Central Kitchen founder Jose Andrés are set to speak at the 2024 Clinton Global Initiative annual meeting in New York on Sept. 23 and 24, the Clinton Foundation announced Thursday.

The theme of this year’s gathering of political, business and philanthropic leaders is “What’s Working” – an effort to shine a spotlight on potential solutions and effective aid in a tumultuous period marked by war, increased income inequality and food insecurity .

Former President Bill Clinton said this year’s Clinton Global Initiative would “double down” on the progress made on the climate crisis, global health, gun violence, and other important issues.

“We started CGI because we wanted to have a meeting where people didn’t just talk about big problems, but where we could roll up our sleeves and get something done,” he said in a statement to The Associated Press. “It’s more important than ever to be optimistic and realize we all have the ability to make a difference.”

Since returning in 2022 after a six-year hiatus, CGI has tried to maintain an optimistic tone, while also developing new ways to help, including the launch last year of The CGI Ukraine Action Network , a collaboration between former Secretary of State Hillary Clinton and Olena Zelenska, the first lady of Ukraine.

“Bill, Chelsea, and I are so inspired by the undoubtable impact of the CGI community – 500 million people affected through programs, partnerships, and solutions that are addressing our climate crisis, economic disparities, equality for women and girls worldwide, and more,” Secretary Clinton said in a statement.

That impact helps CGI draw a wide range of leaders, including Barbados Prime Minister Mia Mottley, Guyana President Mohamed Irfaan Ali, and Kosovo President Vjosa Osmani.

The Duke of Sussex plans to discuss the launch of The Archewell Foundation Parents’ Network, an initiative supporting parents whose children have suffered or died due to online harms. He also plans to address his nonprofit’s collaboration with the World Health Organization and others to end violence against children, an issue he and his wife Meghan outlined on a recent trip to Colombia .

Water.org co-founder and Oscar winner Damon is expected to discuss the status of the $1 billion plan he announced in 2022 to give 100 million people in Africa, Asia and Latin America lasting access to water and sanitation.

Business leaders scheduled for the conference, which runs at the same time as United Nations General Assembly week, include Chobani CEO Hamdi Ulukaya, Gap CEO Richard Dickson, IKEA CEO Jesper Brodin, Mastercard CEO Michael Miebach, Moderna Chairman Noubar Afeyan, Pinterest CEO Bill Ready, Pfizer CEO Albert Bourla, and U.S. Treasury Secretary Janet Yellen.

Andrés is expected to discuss how he turned World Central Kitchen into one of the fastest growing humanitarian nonprofits with a focus on feeding people quickly in the aftermath of disasters or the outbreak of war. After seven World Central Kitchen workers were killed earlier this year by an Israeli airstrike in Gaza, Andrés said, "Their examples should inspire us to do better, to be better.”

Other philanthropic leaders set to speak include Emerson Collective Founder Laurene Powell Jobs, Ford Foundation President Darren Walker, Hispanic Federation CEO Frankie Miranda, Human Rights Campaign President Kelley Robinson, International Rescue Committee CEO David Miliband, and World Health Organization Director-General Tedros Adhanom Ghebreyesus.

Sam Bencheghib, co-founder of the Indonesia-based Sungai Watch, plans to attend this year’s CGI seeking funding for his nonprofit which places barriers in rivers to prevent pollution from reaching the ocean and then removes the trash collected. At previous CGI meetings, he made contacts that resulted in Sungai Watch becoming one of The Elevate Prize Foundation’s 2024 winners.

Last year, Bencheghib attended CGI to make a commitment to expand Sungai Watch’s work to Jakarta and its rivers. His nonprofit will make good on that commitment later this year.

But Bencheghib said he is also proud to bring something tangible to this year’s CGI, especially considering the “What’s Working” theme. He will showcase furniture created out of the plastic bags pulled from the polluted rivers by his new social enterprise Sungai Design.

The company turns 500 plastic bags into a bench; 2,000 plastic bags become a lounge chair.

“Fighting plastic pollution definitely feels never-ending,” Bencheghib said. “Forty percent of the trash we collect are these plastic bags and they are not recyclable in this country … We were looking for a way to turn plastic bags into something that is a little more aesthetically pleasing, something that is a great conversation starter, that raises awareness about what that plastic bag can become if you don’t throw it into the river and if the right setup is in place.”

Associated Press coverage of philanthropy and nonprofits receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content. For all of AP’s philanthropy coverage, visit https://apnews.com/hub/philanthropy .