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Fast and accountable: how the global health and governance communities reflect on pandemic preparedness and response
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Image Credit: TAI

As we move to a new phase of the COVID-19 pandemic, leading experts, practitioners and funders are reflecting on governance lessons for future pandemics. Last week, during the Transparency and Accountability Initiative’s (TAI) launch of its new report on Strengthening Pandemic Governance, we had the unique opportunity to hear from leaders from governments, civil society, global institutions, and funders about their lessons and experiences with pandemic governance.  Recommendations such as the importance of building on existing institutional structures, of reliable data and combating misinformation, leveraging procurement transparency and investing in civil society roles all emerged from this discussion. Above all, there is value in shared learning and action across the health and transparency, participation and accountability communities. You can see the entire session here, and in this post, we share some insights and reflections shared during the event.

Civil society successes and future needs. 

Many panelists highlighted the critical role that civil society played in combatting many of the major governance challenges of the pandemic.  Wangari Ng’ang’a, Senior Health Advisor to the Executive Office of the President in the Republic of Kenya, shared one reflection of how civil society helped to combat disinformation in Kenya:

I want to remind us that, at the beginning of pandemic, accountability did not look like the usual way we see it, with the magnitude of disinformation happening at time… To date, 90% of cases recorded in Kenya are asymptomatic, and so it becomes difficult to convince general populace that this virus is out there… So one of the things that civil society was good at was to ensure that what is out there is visible, but it is different from what we are seeing at home.

However, panelists including Mariam Claeson of the Karolinska Institute also acknowledged that the role of civil society still needs to be elevated in future responses:

When we have new entities like the Global Health Threats Council, we need to ensure that the transparency community and civil society are an integral part of that, not just annual consultations … That they are part of new boards and part of the decision-making as well.

Challenges and opportunities with procurement transparency. 

While panelists discussed the many breakdowns that occurred with medical supplies during COVID-19, there were also several bright spots discussed in which state and non-state actors provided oversight and accountability to combat corruption in procurement.  Zoia Zamikhovska of the Open Contracting Partnership expanded on one example from Lithuania:

In Lithuania, after some months of COVID, civil society organizations decided to analyze how the government dealt with procurement, and for this purpose they opened a data dashboard tracking all COVID procurement using open contracting data standards. On the dashboard, you can see who procured, what was procured, and for what price.  You can track if there was risky behavior… The main goal for us is not just to collect information but to analyze it and use it for the transformation of the supply system.  That was the main impact from Lithuania, that after analyzing data from the dashboard, they moved forward with open contracting.

However, Dr. Ng’ang’a also expressed some caution regarding how we interpret procurement numbers and whether discrepancies are born out of corruption or malicious actions or uncertainty:

It was a kind of a cat and mouse game because in March you order a pair of gloves and it costs 10 times what it would have in August.  But you place the orders because of global supply chain issues.  So looking back now, a lot of things seem difficult to explain, but it was in the context of that time and required a speed and agility. 

The value of building on existing structures. 

While panelists shared a diverse set of approaches to mitigating pandemic governance challenges, one consistent message emerged – that strategies were more effective when they build on existing institutions and policies.  While this is not surprising, it does emphasize the value of investing in stronger policies and institutions now in preparation for the next emergency.

Zoia Zamikhovska shared one example from open procurement:

If we have well-structured, open, and high quality of data in place, our governments could move faster because they are not blind about prices existing on market, not blind about suppliers on the market. All in all, this could mitigate the risk of corruption, misuse of funding, or being fooled by companies that are so called “multi-purpose companies” or that have been just established before winning of the contract. 

Nathan Blanchet of Results for Development (R4D) shared other important examples from Ghana:

Early on in the pandemic, the President established an inter-ministerial task force to conduct a multisectoral response. They got that starting piece right.  There was political leadership, communicated by the president himself.  And then they set up the technical support. The Ministry of Health and World Health Organization co-chaired a technical committee and drew on experts from multiple ministries. They set up a coordinating secretariat which R4D had the opportunity to support. That secretariat pulled in technical advisors to support the regular committees, and they were able to provide a good amount of technical advice and coordination to not recreate the wheel.  They leveraged existing institutions and processes in Ghana to tailor some of the responses. 

 

The need to build good data that is shared and understood widely. 

Transparency requires good data, and accountability and participation requires that people in all parts of the health systems (including patients and communities) have the capacity to understand the data.  Miriam Claeson of the Karolinska Institute highlighted this need in her remarks:

It is an agreement on metrics and data sharing. How can we hold global or national level entities accountable if we don’t have standard metrics by which to measure progress and understand what is going on to tell if our strategy is working.  We need data and open access.  That is so basic, but we really need to strengthen that.  Second, in an environment with increasingly alternative facts and a lack of even technical consensus, it becomes even more important to have scientific literacy.  Civil society, media, they all need to know where to go to get information and to be able to question that information.  From my country experience, what I have missed in our weekly media events is the tough questions.  I wanted to hear, “Okay, if you say we don’t need to wear masks, what is the source of that info?” 

Trusted intermediaries proved important in translating health messages. As Dr. Ng’ang’a noted government should use mouthpieces trusted by society. 

For us [in Kenya] we had interfaith council which came in very strongly, developed a protocol, very useful.  It came from bishop, from imam, from people who have power in theses spaces.

Cross-sectoral learning opportunities. 

Finally and perhaps most immediately, there was a call from panelists and participants alike to capitalize on the clear learning and collaboration opportunities across the global health and TPA fields.  Dana Hovig of the Hewlett Foundation drove home this point in his concluding comments:

The governance field could learn from the health sector about measurement and complex adaptive systems thinking.  And the TPA field is much more comfortable talking about power and politics and elite capture.  So it is this issue of power and elite capture that is central to our new Hewlett strategy, but also to effective and accountable governance and pandemic preparedness… Expenditure, for example, is largely captured by tertiary care and urban elites, and primary healthcare (PHC) is starved for resources.  And PHC is fundamental to pandemic preparedness.  It pays for contact tracing, for information on the frontline, for vaccines… The health field can learn from the TPA field about how to work with movements and with civil society to be a countervailing force, and how to increase budget transparency…  [Otherwise, in the next health emergency], the rich will be just fine like they were in this pandemic, and it will be rural areas that will suffer again.

 

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