Chinese Global Health Diplomacy in Africa: Opportunities and Challenges.

China has become a key actor in global health diplomacy, particularly in Africa, but little attention has been given to the evolution of Chinese health assistance to African states. This paper conceptualizes Chinese health diplomacy in Africa over the past fifty years through three analytic frameworks: realist vs. constructivist motivations in international relations, vertical vs. horizontal initiatives for health assistance, and bilateral vs. multilateral approaches to global health. Drawing lessons from the evolution of American health assistance, we argue that a better understanding of these frameworks-recognizing why countries pursue health diplomacy, what vertical and horizontal strategies they use, and how they engage in this work bilaterally or multilaterally-could improve global health diplomacy.

The Paradox of Happiness: Health and Human Rights in the Kingdom of Bhutan.

The Kingdom of Bhutan is seeking to progressively realize the human right to health without addressing the cross-cutting human rights principles essential to a rights-based approach to health. Through a landscape analysis of the Bhutanese health system, documentary review of Bhutanese reporting to the United Nations human rights system, and semi-structured interviews with health policymakers in Bhutan, this study examines the normative foundations of Bhutan's focus on "a more meaningful purpose for development than just mere material satisfaction." Under this development paradigm of Gross National Happiness, the Bhutanese health system meets select normative foundations of the right to health, seeking to guarantee the availability, accessibility, acceptability, and quality of health care and underlying determinants of health. However, where Bhutan continues to restrict the rights of minority populations-failing to address the ways in which human rights are indivisible, interdependent, and interrelated-additional reforms will be necessary to realize the right to health. Given the continuing prevalence of minority rights violations in the region, this study raises research questions for comparative studies in other rights-denying national contexts and advocacy approaches to advance principles of non-discrimination, participation, and accountability through health policy.

Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change.

While reaching consensus on future plans to address current global health challenges is far from easy, there is broad agreement that reductionist approaches that suggest a limited set of targeted interventions to improve health around the world are inadequate. We argue that a comprehensive systems perspective should guide health practice, education, research and policy. We propose key 'systems thinking' tools and strategies that have the potential for transformational change in health systems. Three overarching themes span these tools and strategies: collaboration across disciplines, sectors and organizations; ongoing, iterative learning; and transformational leadership. The proposed tools and strategies in this paper can be applied, in varying degrees, to every organization within health systems, from families and communities to national ministries of health. While our categorization is necessarily incomplete, this initial effort will provide a valuable contribution to the health systems strengthening debate, as the need for a more systemic, rigorous perspective in health has never been greater.