Beyond Health: Last mile good governance

The “top down” crisis. The response to COVID-19 requires concerted, effective action at every level – especially the community level. Community leaders must take action to generate awareness, achieve behavior change, protect the most vulnerable and care for the infected.

Individual behavior is the “cure”: To date COVID-19 has no treatment drugs or vaccine, and only limited access to testing. The only way to address the crisis is to ensure every person takes responsibility for physical distancing and hygiene. Given global mobility, this means reaching the most remote, “last person” with accurate information, and exerting physical pressure to ensure their compliance and reduce stigma.

Challenge to local governance. While national leaders can exhort on mass media, compliance boils down to community action – to the “last mile” of governance. In some of the most remote and impoverished rural communities, community leaders – both official representatives and voluntary associations – are ensuring these messages are reaching that last person. As with the AIDS pandemic, Silence = Death.

SDG 16: The universally adopted framework for action is Agenda 2030: the Sustainable Development Goals adopted in 2015. Unlike previous frameworks, the SDGs mandate that we “build effective, accountable and inclusive institutions at all levels.Target 16.7 is “Ensure responsive, inclusive, participatory and representative decision-making at all levels.” 

Subsidiarity. What does “at all levels” mean? The principle of subsidiarity states that, as a matter of human dignity, decisions should be taken at levels as close to people as is practical. This means that decisions on primary health and education fall to the community level; hospitals and colleges may come under the district level; highways and international relations at the national level. As infectious disease knows no borders, the World Health Organization is accountable for setting standards and recommending best practices.

Governance is not just Government. SDG 16 is not just about the government. Inclusive, participatory decision making calls for strong partnership between elected representatives, professional civil servants and the civil society organizations through which women, youth or other groups can express collective voice.