The Global Fund and the re-configuration and re-emergence of ‘civil society’: Widening or closing the democratic deficit?

Abstract

The past decade has witnessed a tremendous growth in the scale and policy influence of civil society in global health governance. The AIDS 'industry' in particular opens up spaces for active mobilisation and participation of non-state actors, which further crystallise with an ever-increasing dominance of global health initiatives. While country evaluations of global initiatives call for a greater participation of 'civil society', the evidence base examining the organisation, nature and operation of 'civil society' and its claims to legitimacy is very thin. Drawing on the case of one of the most visible players in the global response to HIV epidemic, the Global Fund to Fight AIDS, Tuberculosis and Malaria, this article seeks to highlight the complex micropolitics of its interactions with civil society. It examines the nature of civil society actors involved in the Fund projects and the processes through which they gain credibility. We argue that the imposition of global structures and principles facilitates a reconfiguration of actors around newer forms of expertise and power centres. In this context, the notion of 'civil society' underplays differences and power dynamics between various institutions and conceals the agency of outsiders under the guise of autonomy of the state and people.

Behind the scenes: International NGOs’ influence on reproductive health policy in Malawi and South Sudan

“…True grassroots mobilisation may, as a consequence, be lacking even though initiatives are widely described as 'locally-led', as scholars have observed in other global health programmes' attempts to strengthen civil society in recipient countries (Doyle & Patel, 2008;Harmer et al, 2013;Kapilashrami & O'Brien, 2012). Meanwhile, little attention is devoted to questioning what might be lost in displacing more rights-based and feminist discourses with seemingly safer technological and public health frames.…”

Social organization and control of tuberculosis: the experience of a Brazilian town

“…In this process, the civil society begins to influence the management of public health care (1) . In Brazil, the political and institutional design of local bodies, such as local health departments, enables social participation, which is a key instrument in decision making and in the development of public policies that guide the Unified Health System/ SUS.…”

NGOs, partnerships, and public-private discontent in Nepal’s health care sector

“…Indeed, from performance-based financing schemes (Eichler et al 2013;Kapilashrami and O'Brien 2012;Renmans et al 2016), shell NGOs (Crane this issue), crowdfunding (Kenworthy this issue) and speculative pandemic financing (Erikson 2015a(Erikson , 2015b, to the entrée of philanthrocapitalism behemoths like the Bill & Melinda Gates Foundation 'creating cures for market failures' (Sparke 2011;see also Birn 2014), the global public health and health care landscape is increasingly business-like. We will suggest that the effects, and affects, of this arc are felt in places like Nepal, where there emerges a sense that, despite rhetoric to the contrary, health (care) is a commodity to buy and sell.…”

“…Scholars have also critically examined how larger-scale PPPs such as the US President's Emergency Plan for Aids Preparedness (PEPFAR), the Global Alliance for Vaccines and Immunizations (GAVI), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) have created new partnership modalities that perpetuate inequalities or competition (Kapilashrami and O'Brien 2012;Storeng and Béhague 2014a;Taylor and Harper 2014), or contribute to subverting or co-opting efforts aimed at strengthening health systems more broadly (Kenworthy 2016;Pfeiffer 2013;Ruckert and Labonté 2014;Storeng 2014 In Nepal, PPPs have similarly emerged as prominent models of collaboration to fund, deliver, and scale health care services and infrastructure; increase 'good governance'; catalyze innovation and research; and improve access, equity, and quality of health care services. Nepal's 'State Non-State Partnerships Policy for the Health Sector' was written in 2012 to pave the way for introducing PPPs to 'improve the health status of the people, especially women, children, the poor and the marginalised sections of the population' (MoHP 2012, 4).…”

“…For example, scholars have studied how PPPs have injected large amounts of money into national budgets, generally for disease-specific and vertical health programming (Peters and Phillips 2004;Pfeiffer 2013;Ramiah and Reich 2005;Ravishankar et al 2009); created new modes of health governance, including taking on core responsibilities of the public sector (Brown 2015;Gerrets 2015;Kapilashrami and O'Brien 2012;Ruckert and Labonté 2014); and generated new standards and forms of evaluation and accountability (Adams 2016;Cueto 2013;Packard 2016;Taylor and Harper 2015;WHO 2008) that are typically unconcerned with community definitions of, or concerns over, notions of 'scale', 4 'success', or 'impact'.…”