The rapid proliferation of international institutions has been a defining feature of the postwar international architecture. Since the end of the Second World War, the international system has seen the creation of thousands of international treaties and organizations that have established rules governing a multitude of issues that range from international security to human rights, and from international trade to the environment.
The concept of an institutional bypass—that is, creating a parallel institution that performs exactly the same function of the dysfunctional institution—has already proven useful for analyzing institutional reforms undertaken at the domestic level. However, it has only recently been suggested as potentially applicable to the global governance context as well. To explore this possibility further, this project brought together a group of researchers who specialize in international governance and asked them whether the concept could be applied to their respective areas of expertise.
Among other things, these discussions revealed at least one major challenge with the use of institutional bypasses in the international context: while the possibility of “bypassing” existing institutions may be counterintuitive in the domestic sphere, it may actually constitute the norm, rather than the exception, in international governance. This is because sovereign states are often assumed to hold a monopoly in the provision of certain services and the performance of certain functions at the domestic level, as is notably the case with policing. Thus, recognizing that states can operate parallel institutions side by side, and in some cases even make them compete with each other, may constitute a paradigm shift for those concerned with institutional reforms and good governance in the domestic sphere. However, this same assumed monopoly does not exist in international governance, where academic researchers have extensively documented the related phenomena of institutional proliferation and duplication.
Accordingly, a question arises as to what value, if any, the concept of institutional bypasses can provide to the existing international governance literature. This is the first—and perhaps the main—challenge in applying the concept of institutional bypasses at the international level, especially since the phenomenon of institutional proliferation and duplication has already been extensively described and scrutinized across multiple disciplines, including law, political science, and sociology. The framing essay in this symposium attempts to provide an answer to this question by presenting a definition of international institutional bypasses, all the while articulating why this concept may prove useful to work on global governance.
Having framed the scope of our project, the other essays in this symposium provide three sets of examples that illustrate the application of international institutional bypasses. The first takes the form of the New Development Bank and the Asian Infrastructure Investment Bank, which serve as bypasses of the World Bank and the Asian Development Bank, respectively. The second set of examples are regional swap lines and regional central banks, which are presented as bypasses of the International Monetary Fund (IMF). Finally, regional institutions in West Africa, and particularly those providing health services, are framed as bypasses of domestic institutions that serve the same functions.
Taken together, these three sets of examples offer interesting illustrations of what we call “horizontal” and “vertical” international bypasses. The former refers to those bypasses that operate within the same jurisdiction as the dominant institution, as in the case of the China-led multilateral development banks that serve as international bypasses of a dominant international institution. By contrast, a vertical bypass means that the dominant institution and the bypass are located at different jurisdictional levels. This notion includes a domestic or a regional institution that tries to bypass an international one, or vice-versa. The international institution can thus be either the dominant institution being bypassed, as illustrated by the IMF essay, or the bypassing one, as illustrated by the West African Health Organization essay.
In summary, our aim in this symposium is to introduce readers to the concept of international institutional bypasses, provide concrete examples, and show that this concept can be of great value in attempts to understand and analyze changes and innovations in global governance. That being said, this is only the first step in a much larger and more ambitious project. Thus, we hope it will also serve as an invitation for readers to further explore the many interesting questions and implications of institutional bypasses in the international context
Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices “often or very often” (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the decisions, policies, or views of the World Health Organization.
In the fall of 2014, the Government of Canada formally split the role of the Chief Public Health Officer (CPHO) into two positions: the CPHO and the President of the Public Health Agency of Canada. Despite concerns raised by the public health community, these changes are consistent with the CPHO's authority. However, the nature of responsible government means that the CPHO cannot simultaneously serve as an independent advocate for policies and programs that might prevent disease and as a senior advisor to the government of the day.
À l'automne 2014, le gouvernement du Canada a annoncé le dédoublement officiel du rôle de l'Administrateur en chef de la santé publique (ACSP) en deux postes : l'ACSP et le président de l'Agence de la santé publique du Canada. Malgré les inquiétudes exprimées dans les milieux de la santé publique, ces changements sont compatibles avec le mandat original de l'ACSP. La nature d'un gouvernement responsable suppose que l'ACSP ne peut à la fois s'instituer en champion indépendant de politiques ou de programmes favorables à la santé et conserver son rôle de conseiller principal du gouvernement du jour.