Second, key principles of public health – the right to health, distributive justice, ques- tions of equality in access to healthcare, and how different people experience good or bad health – must be re-engaged with as a matter of policy practice (see Chapters 4, 10, 12, 25, and 28). Results-based frameworks and the need for a return on investment should not exclude such commitments and principles. One way of reintroducing these themes is to bring the public back into discussions on global health and making the private – includ- ing philanthropic organizations – subject to the same accountability and transparency structures as public bodies, whether governmental or intergovernmental. Whilst private actors may not be spending taxpayers’ money, they have considerable influence on the health of the world’s population. The plurality of actors and ideas is a unique and pos- itive component of global health, yet such plurality needs to translate to decision- and policy-making and be held to account.
Third, global health policy must be designed in-country, by the government, as the elected government through public engagement and discussion sees fit. Global institutions such as the World Bank and the Global Fund should provide support through finance and as such can make recommendations, but such recommendations should not form the basis of conditional lending. Country-based agendas will make health strategies more context- specific, will reduce the burden on state-based health agencies that often have to juggle competing donor demands, and will avoid repetition in the formation of health policy. Focusing on country-based strategies will invert current structures of policy-making so that implementers of policy at the local level become the policy formulators and those who currently make policy at the global level concentrate on working with countries on effective implementation.