Sonja Bartsch

The Role of Southern Actors in Global Governance: The Fight against HIV/AIDS

This paper analyses the role of actors from developing countries in global processes of policy making and governance. To systematically examine the channels of influence of Southern actors and the interactions in global governance it develops the concept of interfaces. It differentiates between organisational, discoursive, legal and resource-transfer interfaces in global governance. This approach is exemplified in the analysis of a specific field of global governance, the global fight against HIV/AIDS. The paper examines the role of Southern governments and non-state actors in the central organisations of global health, their influence in debates and discourses on strategies to fight HIV/AIDS, and the financing mechanisms that were introduced to fight HIV/AIDS in the developing world. It shows that albeit actors from Northern countries dominate global governance in general, in particular areas the current institutional setting of global governance provides significant opportunities for rather weak actors such as civil society organisations and governments from the South to influence strategies and policies.

Interfaces: a Concept for the Analysis of Global Health Governance

In the introduction we summarized the basic aspects of the relationship between globalization, poverty and health and briefly referred to the developments that led to the emergence of the current structures of global health governance (GHG). In this chapter we will develop an analytical approach towards a better understanding of this GHG architecture, which combines International Relations theory with a concept to analyse the linkages between global governance actors.

The Role of Civil Society Organizations in Global Health Governance

Civil society organizations (CSOs) have been around much longer than the current debate suggests, with the Anti-Slavery Society (1839) and the International Committee of the Red Cross (1863) being among the first CSOs to be established in the nineteenth century. Particularly in the field of health, CSOs have always played an important role in the provision of medical services or the realization of humanitarian relief, especially in the developing world. However, it can be observed that both the quantity and the quality of their activities as actors of global health governance (GHG) have increased since the 1980s. According to different studies (for example Anheier et al. 2004; UIA 2004) there are now approximately 3000 international CSOs that belong directly to the health sector (of approximately 51 000–59 000 international CSOs altogether).

Nichtregierungsorganisationen als Akteure der Global Health Governance — Interaktion zwischen Kooperation und Konflikt

Nichtregierungsorganisationen (NGOs) gibt es schon bedeutend langer als die aktuelle, bisweilen auch ein wenig modische Debatte glauben macht. So nahmen die Anti-Slavery Society (1839) und das Internationale Rote Kreuz (1869) ihre Arbeit bereits Mitte des 19. Jahrhunderts auf. Speziell im Gesundheitsbereich sind schon seit langem zahlreiche NGOs beispielsweise in armeren Landern an der Versorgung Kranker beteiligt oder in Katastrophen helfend tatig. Dennoch kann festgestellt werden, dass NGOs seit den 1980er Jahren in der globalen Politik und auch im Gesundheitssektor sowohl eine neue Quantitat als auch — hinsichtlich des politischen Einflusses und der Tatigkeitsbereiche — eine neue Qualitat erreicht haben.

Introduction: Globalization, HIV/AIDS and the Rise of Global Health Governance

After around fifteen years in which North–South relations have focused on the debt crisis, structural adjustment and global economic governance, issues of social development and, in particular, health-related concerns have emerged as central themes in the dialogue. Two issues have been at the forefront of public attention. On the one hand, infectious diseases not only constitute a threat for global public health, but also threaten the social and economic stability in the developing world (with HIV/AIDS at the centre of attention), whilst on the other hand, significant institutional changes are currently taking place, leading towards the emergence of an increasingly complex system of global governance. The prominence of these two issues reflects the fundamental changes that have occurred in global health since the Alma Ata Declaration of ‘Health for All’ and the establishment of primary health care systems under the leadership of the World Health Organization (WHO) were at the centre of international health politics.

Conclusion: Global Health Governance and the Fight Against HIV/AIDS in a Post-Westphalian World

In modem times, the fight against infectious diseases has always depended on international cooperation, requiring nations to coordinate their health and trade strategies with each other. As we have shown in the previous chapters, however, the need to create a global response has never been stronger than in the case of the HIV/AIDS epidemic, which seems in turn to have heightened global awareness in the cases of more recent epidemic threats like those of SARS and Avian Flu. After neo-liberalism and the early structural adjustment programmes had given primary attention to macroeconomic policies, the need to improve health conditions in poor countries as a precondition for economic growth (CMH 2001), fighting poverty and improving security1 again became a central part of the global political agenda during the 1990s. This new priority for health, that included the recognition of large inequalities in global health as a threat for rich countries, became one important dimension in framing the public perception of the fight against HIV/AIDS and strengthening the role of global civil society in conflicts around access to medicines.