Multi-Level Pro-Poor Health Governance, Statistical Information Flows, and the Role of Regional Organizations in South-America and Southern Africa

In the past decades, health governance has become multi-layered as the combined result of decentralisation, regional integration and the emergence of new actors nationally and internationally. Whereas this has –in principle – enhanced the installed capacity for health response worldwide, this complexity also poses serious challenges for health governance and policy-making. This paper focuses on one of these challenges, namely the organisation of statistical information flows at and between governance levels, and the emerging role that regional organisations play therein. Our aim is to understand the extent to which statistics are regionally coordinated and the role regional organisations are playing with respect to national health information systems.

In this paper, we address this aim by analysing regional to national-level data flows with the use of two case studies focusing on UNASUR (Bolivia and Paraguay) and SADC (Swaziland and Zambia). Special attention is given to pro-poor health policies, those health policies that contribute to the reduction of poverty and inequities. Our results demonstrate that health data is shared at various levels. This takes place to a greater extent at the global-country and regional-country levels, and to a lesser extent at the regional-global levels. There is potential for greater interaction between the global and regional levels, considering the expertise and involvement of UNASUR and SADC in health. Information flows between regional and national bodies are limited and the quality and reliability of this data is constrained by individual Member States’ information systems. Having greater access to better data would greatly support Member States’ focus on addressing the social determinants of health and reducing poverty in their countries. This has important implications not only for countries but to inform regional policy development in other areas. By serving as a foundation for building indicator-based monitoring tools, improving health information systems at both regional and national levels can generate better informed policies that address poverty and access to health. In addition, making this data available would provide a solid basis on which to identify the contribution of these organizations and ensure governments are upholding their commitments to addressing health challenges and reducing poverty. The rise of regional-level influence must be capitalised on to address poverty, particularly in the framework of the sustainable development goals.