Trojan Multilateralism: Global Cooperation in Health (Global Policy 4(4), 2013, pp 325–335)

Full title: Trojan Multilateralism: Global Cooperation in Health

Authors: Devi Sridhar,  Ngaire Woods

Type: Journal Article

Abstract

This article argues that recent global health cooperation has been marked by two trends. First, there has been a highly successful proliferation of vertical funds to fight specific diseases. These are characterized by narrower problem-based mandates; multistakeholder governance; voluntary and discretionary funding; no in-country presence for the delivery of assistance; and an output-based legitimacy (based on effectiveness, not process). The rise of new initiatives with these characteristics has dovetailed with an increase in the funding of international organizations. However, the latter has not necessarily strengthened multilateralism. Instead, rapid increases in discretionary earmarked funding to the WHO and World Bank, which we call Trojan multilateralism, has replicated features of the vertical funds. With what consequences for international cooperation? Using principal–agent theory, we find a mixed picture. International organizations are being redirected by specific incentives. However, two constraints on bilateral control are not shifting. There is a persistent asymmetry of information between the WHO or the World Bank and individual member states, which gives the former a degree of autonomy. Equally, there are persistent obstacles to tightening bilateral monitoring of multilateral action. We conclude that the positive lessons to be drawn from vertical initiatives need to be balanced by the risks posed from a convergence of vertical initiatives and Trojan multilateralism.

The article is available for download here.

Author Bios

Professor Ngaire Woods is the inaugural Dean of the Blavatnik School of Government and Professor of International Political Economy. Her research focuses on global economic governance, the challenges of globalization, global development, and the role of international institutions. She founded and is the Director of the Global Economic Governance Programme. She is co-founder (with Robert O. Keohane) of the Oxford-Princeton Global Leaders Fellowship programme. She lead the creation of the Blavatnik School of Government at Oxford University and, before her appointment as Dean, served as the School’s Academic Director.  For more information about Professor Woods, please see her people page

Devi Sridhar is a Senior Lecturer in Global Health Policy at the University of Edinburgh and a Senior Research Fellow at the Blavatnik School of Government at Oxford University. She currently leads the global governance workpackage of the EU FP7 project Go4Health (Setting health-related development goals beyond 2015) and is PI of the project 'Research Priorities to Reduce Global Child Mortality: Integrating Governance and Epidemiology'.