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 2. The challenges

There is a huge divide between the theory and practice of the GSPA implementation, between the complex provisions enshrined in the text and the practice of their enactment in countries. The formidable challenge of today is to move from the negotiated framework to meaningful interventions at country level.

Operationalising the GSPA is a complex task that requires a lot of knowledge and work, as well as the development of new skills and policies at national and regional level. If they want to succeed, governments need to adopt a multidisciplinary approach to translate the concepts spelled out in the GSPA into concrete, home-grown, outcome-oriented, sustainable interventions, well adapted to their specific needs and particular context. Developing countries’ governments need to think strategically on how to positively use the GSPA, and select those elements and actions that are most relevant to their needs, to plan a national innovation strategy that is inclusive enough to serve the whole of society.

Confronted with the scarcity or financial and human resources, low income countries often focus on immediate solutions and fail to invest in innovation. Countries need to find an appropriate balance between short and long-term challenges and should consider devoting a portion of their resources to research and innovation for health, as part of more sustainable strategies.

Increasing evidence demonstrates that, in the particular context of development, innovation has to be understood not only as research on new tools or the adaptation of existing tools for new local application and relevance, but also as the designing and provision of new strategies to use these tools, based on new social, fiscal or economic policies that can create an enabling environment for knowledge application.

To add to the complexity, there is little coherence in the way in which the international community deals with some of the issues. While the current innovation pipeline has never been so promising, priorities are often set by donors - public and private, including foundations – rather than by countries themselves. Coordination among the many new entities involved in R&D and access initiatives is very limited. The outcome is fragmentation of the global health governance, duplication of efforts, wasteful use of resources, and poor accountability to the international community – and even less to societies in greatest need, the ones supposed to decide on their innovation and access priorities and policies.
Therefore, when confronted with the current scenario, with the GSPA complexity and the variety of possible approaches, countries have considerable difficulties in finding their ways and making informed choices. Moreover, most of the policymakers and professionals from various sectors who are supposed/expected to adapt the GSPA to their national situation and priorities for implementation have not been directly involved in the international negotiations. The exercise at the national level should thus start with building the adequate level of knowledge and developing a common understanding among all relevant stakeholders, about implementation requirements. Designing appropriate tools to this end is a priority. This approach would contribute to utilising and strengthening relevant capacities in the country, and to developing effective strategies well inserted within a sustainable national effort.
The GSPA is based on a needs-driven approach. At national and regional level, this entails undertaking an in-depth analysis of public health and innovation priorities – taking advantage of existing knowledge and capacities – and building the policy space and the related strategies that can best address gaps in the public interest To this end, countries should commit to setting up the appropriate mechanisms to shape a comprehensive approach and a shared vision in dealing with the GSPA among concerned actors. They should avoid jumping on “easy” priorities and emulating “given” models or solutions, as well as leaving controversial issues aside.


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