Global Health Architecture and Governance

Introduction

Global health architecture is the constellation of institutions, rules, financing arrangements, technical networks and political processes through which health challenges that cross national borders are addressed. It includes formal intergovernmental organisations, development banks, bilateral agencies, civil-society organisations, philanthropic foundations, private firms and partnerships among these actors. The architecture is not a single hierarchy. It is a plural, negotiated and sometimes fragmented system in which authority is distributed unevenly.

For health-care managers, understanding this architecture is essential. National programmes are frequently financed, technically supported, monitored or regulated through international institutions. A ministry of health may therefore need to interpret a World Health Organization (WHO) guideline, negotiate World Bank financing, coordinate a donor-funded project, manage an NGO consortium and report results to a global partnership—all while remaining accountable to citizens and domestic institutions.

The central governance problem is to align global cooperation with national ownership, public accountability, equity and health-system sustainability. International action can mobilise resources and expertise, but it can also create duplication, conditionality, reporting burdens and conflicts of interest.

Learning Objectives

By the end of this chapter, the reader should be able to:

1. Explain the structure and evolution of global health architecture.
2. Distinguish the mandates, authorities and accountability arrangements of major global health actors.
3. Analyse how financing, norms, partnerships and political power shape health governance.
4. Assess the advantages and limitations of multilateral, bilateral, philanthropic, NGO and public–private approaches.
5. Apply a governance framework to a complex national health programme.
6. Recommend mechanisms that improve coordination, transparency, equity and accountability.

1. Meaning and Evolution of Global Health Architecture

1.1 From international health to global health

Traditional international health focused largely on relations between states, especially disease control, quarantine and technical assistance. Global health has a broader concern: improving health and achieving health equity for all people, with particular attention to problems whose causes and solutions exceed national boundaries. These include pandemics, antimicrobial resistance, climate-related health risks, migration, non-communicable diseases, digital health and the commercial determinants of health.

Global health governance refers to the formal and informal institutions, processes and practices through which collective decisions affecting health are made and implemented. Governance is broader than government. Governments possess legal authority, but non-state actors influence standards, financing, research, service delivery and public debate.

1.2 Historical phases

The architecture has developed through overlapping phases:

• International sanitary cooperation: nineteenth-century efforts addressed quarantine and epidemics affecting trade and travel.
• Post-1945 multilateralism: the United Nations system and WHO created a formal basis for international cooperation. WHO was established in 1948 with a constitutional objective of attaining the highest possible level of health.
• Primary health care and health as a right: the 1978 Alma-Ata Declaration promoted comprehensive primary health care, participation and intersectoral action.
• Selective and disease-specific programmes: from the 1980s and 1990s, financing often concentrated on high-priority diseases and measurable interventions.
• Millennium and Sustainable Development Goals: global targets strengthened results-based financing and measurement, while sometimes encouraging vertical programmes.
• Partnership and network governance: since the 2000s, foundations, NGOs, pharmaceutical companies and public–private partnerships have assumed greater importance.
• Resilience and planetary health: recent debates emphasise preparedness, universal health coverage, climate change, antimicrobial resistance and the need to strengthen national systems.

This evolution has produced institutional innovation but also fragmentation. A single country may receive support from multiple initiatives with different indicators, procurement procedures and reporting cycles.

2. A Framework for Analysing Global Health Institutions

An institution should not be assessed only by its public image or financial size. Five dimensions are particularly useful:

1. Mandate: What problem is the institution authorised or designed to address?
2. Authority: What legal, financial, technical or convening powers does it possess?
3. Instruments: Does it issue norms, provide grants or loans, deliver services, conduct research, procure commodities or influence policy?
4. Accountability: To whom must it explain decisions, spending and results?
5. Equity and legitimacy: Whose interests are represented, and who bears the costs and benefits?

Authority can be divided into several forms. Legal authority derives from treaties, constitutions or domestic law. Financial authority arises from control over grants, loans or procurement. Technical authority depends on expertise and credible evidence. Moral authority comes from perceived legitimacy and commitment to public values. Network authority is the capacity to convene and coordinate actors.

These forms may diverge. WHO has substantial technical and normative authority but limited direct enforcement power. A development bank may have considerable financial leverage but not the same specialised health legitimacy. A foundation may be influential because of its resources, although it is not democratically elected.

2.1 A governance accountability chain

A useful analytical chain is:

Inputs → decisions → implementation → outputs → outcomes → public value

For example, donor funds are inputs; a ministry’s allocation decision is a governance action; clinics implement services; vaccinated children are an output; reduced disease is an outcome; and improved, equitable population health is public value. Accountability should examine each link rather than reward only expenditure or activity counts.

3. Major Actors and Their Roles

3.1 The World Health Organization

WHO is the specialised agency of the United Nations responsible for international public health. Its constitutional functions include directing and coordinating international health work, assisting governments, promoting research, developing standards and providing technical cooperation.

WHO’s principal instruments include:

• evidence reviews, guidelines and technical standards;
• surveillance and early-warning functions;
• emergency response coordination;
• support for national policy and health-system strengthening;
• international negotiations and convening;
• normative instruments such as regulations and frameworks.

The International Health Regulations (IHR) provide a legally binding framework for states concerning the prevention, detection and response to public-health risks that may cross borders. Their effectiveness depends heavily on national capacities, timely reporting and political cooperation. WHO does not operate as a world government; it generally cannot directly compel states to implement every recommendation.

WHO’s accountability is multidimensional. It is accountable to its Member States through governing bodies and approved programmes, to donors through financing agreements, and to the global public through expectations of scientific integrity and impartiality. This creates tensions. Earmarked voluntary contributions may support important programmes but can also influence priorities and reduce organisational flexibility. WHO must therefore protect technical independence, disclose conflicts of interest and align external funding with collectively agreed priorities.

3.2 Other United Nations agencies

The UN system contains agencies with different mandates that affect health:

• UNICEF focuses on children, immunisation, nutrition, water, sanitation and adolescent well-being.
• UNFPA supports sexual and reproductive health, population data and maternal health.
• UNDP contributes to governance, poverty reduction, institutional capacity and development financing.
• UNAIDS coordinates the global response to HIV and supports rights-based approaches.
• UNHCR addresses the health needs of refugees and displaced populations.
• IOM works on migration health and population mobility.
• FAO and WOAH contribute to food systems, animal health and One Health approaches.
• ILO addresses labour standards, social protection and occupational health.
• UN Environment contributes to environmental determinants and pollution-related health risks.

The UN’s strength is its universal membership, political legitimacy and ability to integrate health with human rights, development, food, labour and humanitarian concerns. Its limitations include bureaucratic complexity, overlapping mandates and dependence on Member State political will.

3.3 The World Bank Group

The World Bank Group supports development through financing, policy analysis, technical assistance and knowledge production. The International Bank for Reconstruction and Development generally lends to middle-income and creditworthy countries, while the International Development Association provides concessional finance to poorer countries. The International Finance Corporation supports private-sector investment, and other group institutions have specialised roles.

In health, the World Bank may finance primary care, health-system reform, social health protection, infrastructure, workforce development and pandemic preparedness. Loans can support large-scale reforms that grants alone cannot finance. The Bank also influences policy through analytical work and dialogue with finance ministries, making it relevant to budget priorities beyond the health ministry.

Its authority is primarily financial and analytical, rather than clinical. Accountability operates through member governments, boards, loan agreements, fiduciary controls, environmental and social safeguards, evaluations and affected communities. A major governance issue is conditionality: reforms linked to financing may improve efficiency, but externally designed conditions can weaken national ownership or impose social costs if distributional consequences are not assessed.

3.4 Regional and other development banks

Regional development banks—such as the African Development Bank, Asian Development Bank, Inter-American Development Bank and regional Islamic development institutions—finance health infrastructure, workforce development, social protection, digital systems and emergency response. Their regional proximity can improve contextual knowledge and policy dialogue.

They may combine sovereign loans, grants, guarantees and technical assistance. However, borrowing creates future repayment obligations and can increase public debt. Project appraisal should therefore examine lifecycle costs, fiscal space, recurrent expenditure and value for money, not only the availability of capital.

3.5 Bilateral agencies

Bilateral agencies represent one government assisting another. Examples include agencies associated with the United States, United Kingdom, Germany, Japan and other donor countries. They may provide grants, technical advisers, commodities, training, research support or budget assistance.

Bilateral cooperation can be responsive and operationally strong. It may mobilise expertise rapidly and develop long-term country relationships. However, it can also reflect donor foreign-policy priorities, tied procurement, short funding cycles and parallel implementation units. Effective bilateral assistance follows national strategies, uses country systems where feasible, publishes commitments and results, and coordinates with other partners.

3.6 Non-governmental organisations

NGOs range from community-based organisations to large international agencies. They may deliver services, conduct advocacy, strengthen community participation, undertake research, monitor rights or provide humanitarian assistance.

NGOs are often able to reach marginalised populations and operate flexibly in fragile settings. Their proximity to communities can improve responsiveness and social accountability. Yet NGO projects may be geographically limited, financially dependent on donors and insufficiently integrated into public systems. Government contracting should therefore specify roles, quality standards, data responsibilities, referral arrangements, safeguarding requirements and transition plans.

NGO accountability is not only upward to donors. It should also be downward to communities through accessible information, complaints mechanisms, participation and protection from exploitation. International NGOs must address power asymmetries between expatriate and local staff and should strengthen local leadership rather than permanently substitute for it.

3.7 Foundations and philanthropic organisations

Foundations can provide risk capital, support innovation, fund research and draw political attention to neglected problems. They often work faster than intergovernmental bodies and can finance initiatives that governments or donors consider too uncertain.

Their governance challenge is legitimacy. Private wealth can shape public priorities without direct democratic authorisation. Foundations may also favour measurable, technology-intensive or disease-specific interventions over less visible system functions such as governance, maintenance and routine primary care. Good practice includes publishing grant criteria, disclosing interests, engaging affected communities, coordinating with national plans and evaluating opportunity costs.

3.8 Public–private partnerships

A public–private partnership (PPP) in global health is a structured collaboration in which public authorities and private actors share resources, responsibilities, risks or benefits. Partners may include governments, multilateral agencies, firms, universities, foundations and civil society.

PPPs can accelerate vaccine development, procurement, diagnostics, digital innovation and supply-chain performance. They can combine public legitimacy with private capital, manufacturing capacity or technical expertise. Their risks include conflicts of interest, opaque contracts, unequal bargaining power, intellectual-property barriers, data exploitation and the prioritisation of profitable markets.

A PPP should therefore specify:

• the public-health objective and success criteria;
• each partner’s financial and operational contribution;
• pricing, affordability and access conditions;
• intellectual-property and data rights;
• independent oversight and audit;
• risk-sharing and liability arrangements;
• conflict-of-interest safeguards;
• arrangements for continuity after donor funding ends.

4. How Global Health Governance Works

4.1 Norm-setting and soft law

Global health rules range from binding instruments to voluntary guidance. Treaties and regulations can create obligations, but implementation remains dependent on national law, resources and administrative capacity. Guidelines, technical standards and targets are often called soft law. They may not be legally enforceable, but they shape expectations, funding decisions, professional practice and reputational incentives.

The authority of a guideline depends on evidence quality, transparency of development, representation of affected populations, feasibility and the credibility of the issuing institution. Managers should distinguish a legal obligation from a recommendation and assess whether guidance fits the national context.

4.2 Financing and the political economy of aid

Health financing is not neutral. Funding flows reflect geopolitical interests, disease burden, advocacy, market incentives and institutional mandates. Earmarked funds may achieve rapid gains in a priority area but can reduce flexibility. Uncoordinated projects can create parallel salaries, information systems and procurement channels.

A useful planning distinction is between:

• additionality: whether external funds add to, rather than replace, domestic health expenditure;
• substitution: whether government reduces its own contribution because donors provide funds;
• fungibility: whether money intended for one purpose changes the allocation of other resources;
• sustainability: whether the country can finance recurrent costs after external support declines.

The impact of a grant should therefore be assessed over its full fiscal and institutional life, not only during the project period.

4.3 Coordination and country ownership

Coordination mechanisms include health-sector working groups, pooled funds, joint reviews, country compacts, common results frameworks and shared procurement systems. Coordination is effective when it reduces transaction costs and improves alignment, rather than merely adding another meeting structure.

Country ownership means more than government endorsement. It includes leadership by national institutions, meaningful participation of communities and civil society, alignment with domestic planning and budgets, and the ability to adapt interventions to local conditions. Ownership should not be used to excuse exclusionary government practice; it must coexist with rights, transparency and participation.

4.4 Accountability and legitimacy

Accountability has at least four dimensions:

Transparency is necessary but insufficient. Publishing information does not guarantee that communities can understand or influence decisions. Accountability also requires answerability—the duty to explain—and enforceability—the possibility of correction or sanction.

5. Critical Governance Issues

5.1 Fragmentation and verticalism

Disease-specific initiatives can deliver rapid, measurable results, particularly where a focused intervention is technically appropriate. However, excessive verticalism can weaken primary care, duplicate reporting and compete for scarce health workers. The managerial response is not to reject targeted programmes but to integrate them into national planning, supply chains, information systems and referral networks.

5.2 Power asymmetry and representation

Global institutions often give wealthier states and large funders greater influence than low-income countries or affected communities. Formal equality of membership does not always produce substantive equality of voice. Representation should therefore be assessed at agenda-setting, financing, technical and evaluation stages.

5.3 Conflicts of interest

Conflicts may involve pharmaceutical firms, food and beverage companies, technology vendors, consultants or organisations whose funding depends on a policy outcome. A conflict is not automatically misconduct, but undisclosed or unmanaged conflicts can undermine trust. Controls include declarations, recusal, independent evidence review, transparent procurement and publication of contracts.

5.4 Data governance and digital health

Global programmes increasingly depend on interoperable data, geospatial tools, predictive analytics and artificial intelligence. These tools can improve surveillance and resource allocation, but they create risks involving privacy, cybersecurity, biased algorithms, exclusion and commercial reuse of data. Governance should define data ownership, lawful use, minimisation, security, retention, cross-border transfer and redress.

AI systems should not be treated as neutral decision-makers. Managers should require validation in the intended population, monitoring for disparate error rates, human oversight and explainable escalation procedures. An algorithm that predicts service demand does not by itself justify denying services to people classified as low priority.

5.5 Emergencies and exceptional powers

During emergencies, speed is vital, but emergency arrangements can weaken consultation, procurement safeguards and human rights. Preparedness should establish decision authority, emergency procurement rules, information-sharing protocols, community engagement and independent review before a crisis occurs. Exceptional measures should be necessary, proportionate, time-limited and subject to oversight.

6. A Managerial Framework for Assessing an External Partner

Before accepting a programme or partnership, a health-care manager can ask:

1. Strategic fit: Does the proposal support national and subnational priorities?
2. Value: What health gain, equity gain or system benefit is expected?
3. Authority: Is the partner legally and technically competent to perform the role?
4. Financing: Are funds additional, predictable and adequate for recurrent costs?
5. Integration: Will the programme use or strengthen national systems?
6. Accountability: Who reports to whom, and what remedies exist for failure?
7. Equity: Which populations may be excluded or disadvantaged?
8. Sustainability: What happens when the grant, loan or contract ends?
9. Integrity: Are conflicts, procurement and data risks controlled?
10. Learning: Are evaluation findings independent, shared and used for adaptation?

A simple decision matrix can score each criterion from 1 (weak) to 5 (strong), provided that the scores are documented and not presented as objective facts. The matrix supports structured judgement; it does not replace political, ethical or technical deliberation.

7. Illustrative Case: Coordinating a Pandemic Vaccine Programme

Background

Consider the fictional country of Lumenia, a lower-middle-income country with a decentralised health system. During a pandemic, Lumenia receives vaccine doses through a multilateral facility, cold-chain equipment through a bilateral agency, an emergency loan from a development bank, community mobilisation from NGOs and digital registration support from a technology company.

Problem

After six months, national coverage is uneven. Urban districts have excess stock, rural districts report shortages, and several partners use different data definitions. Health workers are uncertain whether the ministry, the multilateral facility or the donor agency controls allocation decisions. Community groups report that migrants and people without identity documents are being excluded.

Analysis

The problem is not simply insufficient supply. It reflects fragmented authority, weak information governance and inadequate equity safeguards. The ministry has legal responsibility for national policy, but external partners have operational influence through procurement, logistics and funding conditions. Separate reporting systems produce inconsistent denominators and conceal stock imbalances.

Approach

The ministry establishes a single national coordination cell chaired by the health secretary, with representation from finance, local governments, civil society, professional bodies, all major partners and affected communities. It adopts:

• one national allocation formula based on population, risk, transmission and access barriers;
• a common data dictionary and reporting schedule;
• public dashboards showing deliveries, stocks and coverage by district and vulnerable group;
• a no-cost access policy that does not require formal identity documents;
• independent monitoring of adverse events and complaints;
• a financing plan for cold-chain maintenance after emergency funds end;
• contractual provisions requiring the technology company to protect data and delete unnecessary personal information.

Partners retain their comparative advantages but operate under the national framework. The development bank links disbursement to system milestones rather than parallel project indicators. NGOs assist with outreach and feedback, while the multilateral facility supports technical standards and supply forecasting.

Outcome

Within three months, stock-outs decline, reporting discrepancies are resolved and coverage improves among rural residents and migrants. The programme does not eliminate all shortages, but decisions become traceable and partners share responsibility for results. A post-programme review identifies the need to finance maintenance and retain the data architecture within public institutions.

Learning points

The case demonstrates that coordination is an exercise of governance, not merely logistics. Clear authority, common information standards, community accountability and sustainability planning are as important as commodities. It also shows that partnership value depends on how actors are integrated into public decision-making, not simply on the number of organisations involved.

8. Best Practices for Global Health Managers

Effective managers should:

• map stakeholders, mandates, incentives and decision rights before implementation;
• align external assistance with national strategies, budgets and information systems;
• negotiate explicit arrangements for recurrent costs and programme transition;
• use shared indicators while preserving information needed for equity analysis;
• publish funding sources, contracts, assumptions and evaluation findings;
• involve communities and local organisations in design and oversight;
• separate technical advice from commercial promotion;
• build local institutional capacity rather than permanent parallel structures;
• conduct distributional and human-rights impact assessments;
• establish complaints, whistle-blowing and safeguarding mechanisms;
• evaluate both intended results and unintended effects.

Contemporary Directions

Global health architecture is moving toward stronger pandemic preparedness, universal health coverage, climate-sensitive health systems, One Health collaboration and more explicit attention to decolonising global health. These directions raise important questions: Who defines expertise? Who controls data and research agendas? How should preparedness be financed between crises? How can private innovation be made affordable and accountable?

There is no single institutional design that resolves these questions. The practical task is to build arrangements that are legitimate, capable, adaptive and equitable. Global health governance should be judged not by institutional activity alone, but by whether it improves health and protects rights for populations that otherwise have the least influence.

Chapter Summary

Global health architecture is a plural system of states, UN agencies, development banks, bilateral agencies, NGOs, foundations and public–private partnerships. Each actor possesses a distinctive combination of mandate, legal, financial, technical, moral and network authority. WHO provides global norms, coordination and technical leadership but depends heavily on Member State cooperation and financing. UN agencies address interconnected health and development concerns, while development banks provide large-scale finance and policy leverage. Bilateral agencies, NGOs and foundations contribute resources, flexibility, community reach and innovation, but may also create fragmentation, dependence or legitimacy concerns. Public–private partnerships can accelerate innovation when contracts, access, data, conflicts of interest and accountability are carefully governed.

Effective governance requires country ownership, coordination, transparency, equity, sustainability and accountability to both funders and affected communities. Managers should assess strategic fit, authority, financing, integration, equity, integrity and long-term sustainability before entering partnerships. The central lesson is that global health institutions are instruments of governance, not substitutes for capable and accountable national health systems.

Key Terms

Global health: Health issues and actions whose determinants or solutions cross national boundaries.

Global health governance: Institutions, rules and processes through which collective health decisions are made and implemented.

Multilateralism: Cooperation among multiple states, usually through common institutions.

WHO: The UN specialised agency responsible for international public health leadership and coordination.

International Health Regulations: A binding framework for managing cross-border public-health risks.

Soft law: Non-binding standards, guidelines or targets that influence behaviour and policy.

Development bank: A financial institution that supports development through loans, grants, guarantees or technical assistance.

Bilateral agency: An agency through which one government provides assistance to another.

NGO: A non-state, not-for-profit organisation engaged in service delivery, advocacy, research or humanitarian action.

Foundation: A philanthropic organisation that uses private assets to fund public or social objectives.

Public–private partnership: A structured collaboration between public and private actors sharing resources, risks or responsibilities.

Country ownership: Leadership and decision-making by national institutions, with meaningful participation of society.

Additionality: The extent to which external finance adds to existing domestic resources.

Fungibility: The possibility that funds designated for one purpose alter the use of other resources.

Vertical programme: A programme focused on a specific disease, population or intervention.

Horizontal health-system approach: An approach strengthening broad system functions such as primary care and workforce capacity.

Social accountability: Mechanisms through which communities influence, monitor and challenge health institutions.

Conflict of interest: A situation in which secondary interests could improperly influence professional or institutional judgement.

One Health: An integrated approach recognising connections among human, animal and environmental health.

Health equity: The absence of avoidable, unfair and remediable differences in health or access to care.

Review Questions

Short Answer Questions

1. What is meant by global health architecture?
2. Identify two forms of authority used by global health institutions.
3. State two principal functions of WHO.
4. What is the difference between bilateral and multilateral assistance?
5. Why can earmarked funding create governance problems?

Long Answer Questions

1. Compare the mandates, authority and accountability of WHO and the World Bank in health-system development.
2. Discuss the potential benefits and risks of public–private partnerships in global health.
3. Explain how NGOs and foundations can contribute to health equity while also creating accountability challenges.
4. Analyse the relationship between country ownership, donor coordination and sustainability.
5. Discuss why transparency alone is insufficient for social accountability.

Analytical / Application Questions

1. A ministry receives funding from five partners, each requiring separate indicators and reporting systems. Design a governance response that reduces fragmentation without losing essential accountability.
2. Evaluate whether a foundation should fund an advanced disease-monitoring platform or primary-care workforce retention in a low-income country. Specify the criteria and evidence you would use.
3. Using the Lumenia case, identify the decision rights of the ministry, multilateral facility, development bank, NGOs and technology firm, and recommend safeguards for equity and data protection.

Multiple Choice Questions with Answers

Question 1

Which form of authority is most directly associated with WHO guidelines and technical standards?

A. Technical and normative authority

B. Military authority

C. Judicial enforcement authority

D. Taxation authority

Correct Answer: A. Technical and normative authority

Question 2

What is a central function of the International Health Regulations?

A. Setting national hospital prices

B. Managing public-health risks that cross national borders

C. Regulating all pharmaceutical patents

D. Financing every national health service

Correct Answer: B. Managing public-health risks that cross national borders

Question 3

Which institution primarily provides development loans, grants and policy analysis rather than clinical guidelines?

A. World Bank

B. WHO

C. UNICEF

D. A community-based NGO

Correct Answer: A. World Bank

Question 4

What does additionality mean in health financing?

A. External funds replace all domestic expenditure

B. External funds add to existing domestic resources

C. Funds can be spent without reporting

D. A programme has multiple donors

Correct Answer: B. External funds add to existing domestic resources

Question 5

Which is a major risk of excessive vertical programming?

A. Improved disease-specific measurement

B. Reduced duplication of services

C. Fragmentation and weakening of broader health-system functions

D. Greater alignment with national systems

Correct Answer: C. Fragmentation and weakening of broader health-system functions

Question 6

Which accountability mechanism is most directly designed to hear and address community concerns?

A. A confidential internal budget forecast

B. A community complaints and response mechanism

C. A donor-only financial audit

D. A private procurement negotiation

Correct Answer: B. A community complaints and response mechanism

Question 7

Why can foundations raise legitimacy concerns in global health governance?

A. They are always legally prohibited from funding health

B. Private wealth may influence public priorities without direct democratic authorisation

C. They cannot fund research or innovation

D. They are controlled by national parliaments

Correct Answer: B. Private wealth may influence public priorities without direct democratic authorisation

Question 8

Which provision is especially important in a public–private digital-health partnership?

A. Leaving data rights unspecified

B. Excluding independent oversight

C. Defining data use, security, retention and accountability

D. Allowing unrestricted commercial reuse

Correct Answer: C. Defining data use, security, retention and accountability

Question 9

A development bank finances a new clinic but does not fund future staffing or maintenance. Which governance issue is most evident?

A. Sustainability and recurrent-cost planning

B. Normative authority

C. Soft-law classification

D. Disease surveillance sensitivity

Correct Answer: A. Sustainability and recurrent-cost planning

Question 10

Which statement best describes global health governance?

A. It is a single hierarchy controlled by WHO

B. It involves only national governments

C. It is a plural system of institutions and processes involving state and non-state actors

D. It is limited to emergency response

Correct Answer: C. It is a plural system of institutions and processes involving state and non-state actors