RISK GOVERNANCE AND STEWARDSHIP FOR A HEALTHY SETTING: IMPROVING COORDINATION FOR HEALTH ACROSS BORDERS

RISK GOVERNANCE AND STEWARDSHIP FOR A HEALTHY SETTING: IMPROVING COORDINATION FOR HEALTH ACROSS BORDERS

WHAT IS HEALTHY BORDERS ABOUT? Places where people experience a range of social and economic changes and health challenges: Rapid economic development Population mobility Environmental and disease threats Poor access to quality health care Places where solutions to these challenges require complex array of institutions and stakeholders 6 countries Multiple government agencies, private sector, communities Support of international organizations

KEY MESSAGES There are common needs across borders to protect health, reduce risks, and ensure access to quality health care all of which require multisectoral cooperation There are a myriad of networks on specific issues, but policy alignment and cohesion has yet to be achieved There is need for harmonisation of policies, regulations, systems, but no single mechanism exist for ensuring health needs of border populations are met; Given multiplicity and complexity of issues and institutions, a collaborative governance framework is appropriate to bring greater alignment of stakeholders

A MENU OF OPTIONS FOR IMPROVED COORDINATION 1. Create new entity for comprehensive coordination 2. Entrust existing regional intergovernmental coordination processes (ie ASEAN) 3. Entrust existing bilateral processes for parallel developments (ie leave to countries to sort out) 4. Networking the networks bring leads for each network together 5. Pragmatic incrementalism - regular dialogue leading to joint action on priority issues 6. Brokerage team 7. MOUs for specific issues 8. Bilateral framework agreements, using model agreement 9. Bilateral harmonisation plus regional funding mechanism

THE ISSUES: A BRIEF RECAP POPULATION/HEALTH POLICY/INSTITUTIONAL Rapid development and increased migration Trans-border environment and disease risks Rights for migrants, including access to health services Quality of care, including medicines, for all border region residents Non-alignment of health systems and regulatory frameworks 6 countries, multiple sectors in each country (including private and community sectors), plus regional organisations How to harness private sector for socially responsible investment Urgent need for disease control vs difficulties of policy harmonisation for migrant issues How to reach communities with diverse languages, cultures and low (health) literacy Need for harmonisation of regulations, financing of public goods and health systems

RANGE OF ISSUES AND NETWORKS migrant workers, migrant women, migrant children communicable disease, emerging diseases, pandemic preparedness environment al health, environment al impact, one health HIV/AIDS, sexual and reproductive health healthy borders Infrastructure and other economic development projects health care, pharmaceutic als, m-health education, social protection, legal rights

SOME EXISTING NETWORKS AND PROCESSES Migration IOM, UNESCAP, ILO, CCSDPT, CARAM-Asia, Mekong Migration Network, WHO Development projects ADB, World Bank, governments Health Ministers - ASEAN Women, children, reproductive health UNICEF, UNFPA, ARROW, Environment and health RFEH, ASEAN, WHO Disease Surveillance MBDS, WHO Pandemic preparedness ASEAN, APEC, WHO Emerging diseases APEIR, ASEAN, WHO HIV/AIDS UNAIDS, WHO, Global Fund, JUNIMA, 7 Sisters, Asian Business Coalition Malaria Global Fund, Malaria Consortium, AP Leaders Malaria Alliance

MODELS OF COORDINATION AND COMMUNICATION ARRANGEMENTS Intergovernmental models that includes the health sector include: ASEAN, EU, CARICOM, SPC, SADC No international model, but health sector examples for US-Mexico border, and US-Canada border, Other sector examples include forestry, fisheries, customs No single regional mechanism for border health exists but various networks in operation: HIV/AIDS, APSED, Mekong Basin Disease Surveillance, Regional Forum on Environment and Health, APEC Health Working Group, Asia-Pacific Leaders Malaria Alliance, Alliance for Healthy Cities, as well as networks for NGOs and businesses

PRINCIPLES FOR INSTITUTIONAL DESIGN IN GOVERNANCE Think: partnerships, win-win, synergy Horses for courses: Command and control suit simple problem, coordination needed for complicated problem, network governance useful for complex problem Different issues may require different degrees of participation, and for different stakeholders: information (provision), consultation (feedback), cooperation (share resources), coordination (align work), vs collaboration (joint work) Arrangements could be evolutionary, and vary according to issue Trade-offs: participation vs transaction cost; time for building trust vs immediate outcomes; high-level leadership and authorising environment vs political sensitivities for action vs practical on-the-ground changes

CONNECTING NETWORK NODES NGOs and ACADEMICS - migrant workers, migrant women, migrant children APSED - communicable disease, emerging diseases, pandemic preparedness RF on Environment and Health - environmental health, environmental impact, one health JUNIMA - HIV/AIDS, sexual and reproductive health healthy borders ADB - infrastructure and other economic development projects WHO - health care, pharmaceuticals, m-health IOM - education, social protection, legal rights

WHAT IS A USEFUL COORDINATION MECHANISM? System-of-systems/ Network the networks Resolves bottlenecks and supports action Efficient for policy alignment, resource mobilisation, decision-making Benefits of economy of scale without high transaction cost Integrates and builds on existing systems Inclusive of perspectives and stakeholders Builds trust transparent communication, recognises mutual interests Adaptive able to take on related issues Sustainable changes are embedded into policies and practices

CORE ELEMENTS OF COORDINATION MECHANISM National focal points Agree information sharing arrangements Regional intersectoral technical committees and network of stakeholders Shared alert system where harmonised cross-border action needs to be taken Shared analytical tools to be applied to policy and project development Links to local actors

CHARACTERISTICS OF COLLABORATIVE GOVERNANCE Independent facilitation across networks clear convening role Clearly identified scope of shared goals, with some shared values Incentives for cooperation Problem-solving orientation Participation by stakeholders in all stages Accountability shared monitoring Preventing problem escalation with decision ladder to resolve issues expeditiously Review, reflection, and adaptation reassess policies and learning, allow parameters to evolve as well as the coordination mechanism itself

CONSIDER POSSIBLE OPTIONS 1. Comprehensive development with new entity 2. Entrust existing regional intergovernmental coordination processes 3. Entrust existing bilateral processes for parallel developments 4. Networking via the network nodes 5. Pragmatic incrementalism through dialogue 6. Brokerage team 7. MOUs for specific issues 8. Bilateral framework agreements, using model agreement 9. Bilateral harmonisation plus regional funding mechanism

MOVING FORWARD Define short and medium agenda, and priority issues to be progressed eg socially responsible infrastructure development, health care coverage and portability of entitlements, management of environmental and disease threats Determine which existing mechanism could act on priority issues, and how and when the identified issue could receive attention by appropriate body Determine what (if any) new mechanisms are necessary and how they might be created Agree on mechanism and process by which agreements about overall governance and coordination can be reached and implemented