Ottawa IHR Workshop:
Summary Comments
Kumanan Wilson
Emerging Themes
1. A recognition of the importance of the IHR
(2005) to managing public health emergencies
2. A recognition of the challenges the IHR poses,
particularly to decentralized states, and those
with limited resources
3. An understanding that the effective
implementation of the IHR involves a
necessary combination of both governance and
capacity
4. An understanding that the changes to public
health governance occurring in many countries
have been influenced not only by the IHR but
also by many other processes
Emerging Themes, cont’d
5. A recognition that every nation is unique
– Have unique governance systems, histories and
experiences
6. An understanding of the importance of the
sovereignty of regional governments within
states
7. A recognition of the importance of public health
collaboration and maintaining effective working
relationships between orders of government
Decentralization vs. centralization
of public health governance
• Both options have inherent tensions
• The IHR and other international events are
imposing greater centralization
• Different instruments to achieve centralization:
– Public health legislation, parallel legislation,funding,
intergovernmental agreements.
• Need to identify the combination of instruments
that will maximize the benefits of centralization
while mitigating its disadvantages
Key questions for future
research
• For what core capacities is it worth considering
moving to more centralized approaches?
• If states can adopt centralized approaches, how
to manage the impact of the top-down structure?
– On relationships, on ensuring capacity, on regional
government jurisdiction/sovereignty
• If states cannot adopt centralized approaches,
what alternatives can be used to ensure regional
(and thus national) compliance with IHR?