Identifying and addressing the governance accountability problem

ABSTRACT

Successive global health crises – from HIV and AIDS to SARS and H5N1 to Ebola – highlight one of the most pressing challenges to global health security: the GAP – the governance accountability problem. Introduced in 2014 in the book entitled, HIV/AIDS and the South African state: The responsibility to respond, this article takes up Alan Whiteside’s challenges, in a book review in these pages, to offer a more comprehensive analysis of the GAP. The GAP [Šehović, A. B. (2014). HIV/AIDS and the South African state: The responsibility to respond. Ashgate Global Health.] posits that there is a disconnect between ad hoc, state and non-state interventions to respond to an epidemic crisis, and the ultimate guarantee for health (security), which remains legally vested with the state. The existence and expansion of such ad hoc solutions result in a negligence: a failure of re-ordering of health rights and responsibilities for health between such actors and the accountable state. The GAP aims to highlight this disjunction. This article first defines the GAP. Second, it asks two questions: First, what is the contribution of the GAP thesis to understanding the emerging health security landscape? Second, what can the GAP offer in terms of practical insight into viable solutions to the re-ordering of state/non-state-based responsibility and accountability for global health security?

KEYWORDS:

• HIV and AIDS
• health rights
• responsibilities
• governance
• accountability

Acknowledgements

In the northern hemisphere’s Winter Term 2017/2018 Dr. Šehović will be acting Professor of International Politics at the University of Potsdam, Germany. Special thanks to Alan Whiteside and Solly Benatar for their comments and encouragement, and the anonymous reviewers at Global Health for their constructive comments towards the publication of this article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 International institutions and organizations, as well as NSAs, can, of course, be held to account in the court of public opinion. Yet this paper is concerned with legal and structural accountability, outside of which these entities operate. Legal and structural accountability remains the purview of states, or Member States, as the case may be, though this is starting to change – as seen in the process of holding the UN to account for importing cholera into Haiti shows.

2 This seems to be recurring as draconian anti-homosexuality laws are being discussed and passed in, for example, Kenya and Uganda. As the governments retract support for HIV and AIDS treatment and care, NSAs are (again) filling the void, sometimes under dangerous conditions.

3 Reference Srebrenica, Bosnia and Herzegovina, for example.

4 The Bill and Melinda Gates Foundation did just this.

Additional information

Funding

Dr. Šehović is part of the EU Horizon2020 project, EL-CSID (European Leadership – Cultural, Science and Innovation Diplomacy) [grant agreement number 693799].