Governance, Not Just Technical Capacity, Determines Whether a Public Health Agency Responds in Time
On July 15, we joined the WHO EPI-WIN webinar on strengthening the governance of national public health agencies (NPHAs), hosted by the WHO Health Emergencies Programme and the Alliance for Health Policy and Systems Research. The session presented three years of joint research across more than 50 national public health agencies worldwide, and it confirmed something we see constantly in our own field work: technical capacity is rarely what determines whether a country responds well to a crisis. Governance is.
No single model, but a shared set of conditions
The cross-country study examined ten national health agencies under three governance models: integrated within the Ministry of Health, structurally separate but supervised by it, or fully independent. The finding that stood out to us was not which model performed best, since none did consistently. What mattered across all three was the combination of three governance factors: clear and enforceable legal mandates, real operational autonomy over staff and budget, and information-sharing arrangements that don't collapse into layers of approval the moment a crisis hits.
The video from Fiji, shown during the session, made the point concrete. A center that scaled its testing capacity from 20 to 500 tests a day with the same staff ended up depending on ad hoc directives from the Prime Minister's office just to coordinate across sectors, because the coordination mechanisms simply hadn't been defined before the emergency arrived.
Our take: governance is designed before the crisis, not during it
This is a pattern we've seen for years in the field. Countries don't usually fail for lack of technical knowledge; they fail for lack of governance mechanisms that activate automatically once technical knowledge alone stops being enough. Legal authority without operational autonomy is a dead letter. Autonomy without predefined data-sharing and financing arrangements turns into lost weeks that, in an emergency, are never recovered.
The point from the discussion that resonated most with us was Kumanan Rasanathan's warning about the "panic and neglect" cycle: institutions get built in reaction to the last outbreak, then lose funding the moment the urgency fades. Breaking that cycle takes sustainable domestic financing, not just external funds that show up and disappear with each emergency.
Three takeaways we're carrying into our own work
Governance is a portfolio, not a checkbox. A strong legal mandate isolated from cross-sector coordination mechanisms and clear emergency financing rules won't produce a faster response. These pieces have to be designed as one interconnected system.
Scientific independence is trust infrastructure. Who gets to authorize what's published, and when, without routing through multiple layers of political approval, isn't a secondary comms detail. As Neil Squires of IANPHI put it during the panel, it's the foundation of an agency's credibility with its own population.
Building a national public health agency is a decade-long process, not an event. Africa CDC's own trajectory, from 13 agencies in 2018 to 27 fully established today, shows what we think of as progressive institutional strengthening: advocacy, legal establishment, operationalization, and continuous improvement are distinct phases that each need distinct support, not one technical assistance package.
Further reading
TDG Impact Global is a multidisciplinary advisory firm based in Singapore, working across Latin America, the Caribbean, and Asia-Pacific on disaster risk management, global health security, and governance and institutional strengthening. From Crisis to Strength, Together.
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