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  • Writer's pictureVijay Krishnarayan

Building a Healthy Relationship

Updated: Feb 4, 2020

I suppose it’s inevitable that as the end of my term as Director-General nears, I reflect on the Commonwealth Foundation’s journey over the past seven years. I’ll always be grateful to our governments for backing a strategic change in direction in 2012. That focussed our work on people’s participation in governance but coming to that agreement wasn’t straight forward. Some took more convincing than others. A refrain I heard often at the time went ‘the Commonwealth Foundation’s proposed emphasis on governance is well and good but we want to see a focus on development.’

‘Intellectual property regimes are also being used to prevent the search for new drugs that protect public health as globally we face up to anti-microbial resistance.’

My response was and remains a rebuttal of a reductionist world view that posits development and governance as dichotomous. All those who share the Foundation’s outlook raised a cheer when SDG 16 made the explicit connection between inclusive governance and better development outcomes. It was a privilege to see how this works in practice while visiting a Commonwealth Foundation grant funded project in Malaysia this month.

Third World Network (TWN) is a well-respected independent, international, research and advocacy organisation, which since 1984 has been taking up issues of concern to the Global South. They recognise that trade agreements between countries include intellectual property clauses that run counter to the internationally ratified Trade Related Intellectual Property Rights (TRIPs) Agreement and a subsequent Declaration on TRIPs and public health. This affirms the right of countries to use the full flexibility of TRIPs to provide access to medicines to all. Intellectual property (IP) regimes are also being used to prevent the search for new drugs that protect public health as globally we face up to anti-microbial resistance.

TWN saw the need for engagement with governments in the global south on the provision of effective and affordable drugs. With funding from the Commonwealth Foundation they are helping the Ministry of Health (MoH) to navigate IP provisions to improve access to medicines and are providing a civil society perspective on the implementation and monitoring of a national action plan on anti-microbial resistance.

As we met with MoH colleagues, their genuine appreciation for the support they had received from TWN in the design, promotion and monitoring of the AMR national action plan was palpable. In 2012 the Ministry widened the focus of the AMR campaign from health professionals to the public at large and this called for considered and sustained civil society engagement. TWN acts as a champion, a trusted interlocutor and convenor. They raise awareness through events and publications and encourage civil society to participate and monitor progress. This is helping to take the AMR campaign to new audiences such as farmers who use antibiotics in their animal husbandry practices.

‘Getting the message across that [anti-microbial resistence] is an imminent threat that requires urgent action by all of us calls for new alliances and ways of working.’

We also met with colleagues from the remarkable Drugs for Neglected Diseases Initiative (DNDI). DNDI was established in recognition of the fact that the research and development of drugs doesn’t serve the interests of many on the global south. According to their research, of the 850 new drugs approved between 2000 and 2011 only 4% were for neglected diseases such as chagas, sleeping sickness and leishmaniasis (which with other neglected diseases accounted for 11% of the global disease burden over the same period). They develop new drugs to address these issues and patent them so they can be made available at an affordable price. In Malaysia they have targeted hepatitis c and have partnered with TWN as they have engaged with the Malaysian government so that one major drug is licensed and made available. In this instance TWN provided technical inputs on the TRIPS implications and opportunities to government policy makers.

I left Malaysia appreciating that the simple question ‘How can the most vulnerable people in society enjoy equitable access to health treatment?’ has a very complex answer. As Dr Ying-Ru Lo, the Head of Mission and WHO Representative to Brunei, Malaysia and Singapore said to us health issues are increasingly multi-sectoral and civil society is well suited to helping government agencies (often working in isolation) to make the connections and form the coalitions that are required to deliver public health.

This is inclusive governance in action and the Malaysian experience shows that it is not a luxury item. Getting the message across that AMR is an imminent threat that requires urgent action by all of us calls for new alliances and ways of working. The joined up approach of public health policy makers, DNDI and TWN on drugs for hepatitis c has contributed to the treatment of more than 1,000 people to date. Inclusive governance isn’t just about improving the decisions that shape people’s lives. It’s also about improving the decisions that save people’s lives. Seven years on from making the decision to change its strategic focus, the Commonwealth Foundation can make the connection between participatory governance and better development outcomes – but all that does is remind us of the amount of work that remains to be done.

This article was originally posted by the Commonwealth Foundation during Vijay’s time as the Director-General.

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