Governments Put WHO’s Independence At Heart Of Reform Debate

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Any employee who has been through a company reform knows that it can be an anxious and stressful period. The experience is no different for the 194 members of the World Health Organization representing their respective countries and the public health interests of their constituents. As the WHO Executive Board digs deep into the fundamental principles of organisational change, preserving the holy member-driven nature of the global public health authority has emerged as the most pressing priority.

Although there is long list of urgent global public health issues before the 132nd WHO Executive Board meeting this week, advancing the reform agenda has dominated discussions that began 21 January.

US Executive Board Member Nils Daulaire emphasised this during an intervention this week: “The most important thing that we are doing here is the reform agenda. This is fundamental to everything we do here. So, we should take the time – evenings, the weekend – to work through this.”

And they will. Members worked through the evening yesterday and will also meet in an informal session Saturday afternoon to focus on reform action items. The WHO secretariat will prepare a list of decisions that need to be taken related to programmes and priority setting, governance, and management with clear indication of where there is consensus or divergence among member states.

Major Funding Changes

One of the major aspects of the reform is the new financing model, which changes the scope of the budget approved by WHO members during their annual assembly.

Until now, members only approve assessed contributions, obligatory payments made by member states, and note the voluntary contributions, left to the discretion of countries and non-governmental entities. Under the new model, members will review an integrated budget, covering both types of contributions.

Gaudenz Silberschmidt, senior advisor to WHO director general, explained the change during a media briefing last week. “In a biennial budget of roughly four billion, this meant adopting one billion and noting three billion, which means the organisation couldn’t control the full four billion, rather it was very decentralised which programme raised the money,” he said.

“So, it’s a fundamental change in the way the organisation is funded to come out of that dilemma of having three-quarters of voluntary contribution, which we can’t change as such, but where we don’t want to be donor driven, but the member states who decide on priorities,” Silberschmidt said.

Member states reviewed yesterday a draft of the twelfth general programme of work, which provides the strategic vision of work of the WHO from 2014-2020, and amendments to financial rules and regulations required to accommodate the new financial model.

Financial “Dialogue” in 2013?

WHO Director General Margaret Chan a highlighted a key new phase in the funding process, outlined in paragraph 125 of the programme of work, described as a “financing dialogue”.

The concept is that following the approval of an integrated budget and programme priorities during the World Health Assembly (WHA), a dialogue would be orchestrated between the member states and “historic” donors, including UN agencies, the Gates Foundation, and the Rockefeller Foundation, according to Chan.

According to the programme of work, “Progress in financing all parts of the budget is made available in as transparent a way as possible, using web technology, indicating who has funded what, and the degrees of specification and/or flexibility. This dialogue ends prior to the beginning of the financial year.”

As discussions moved toward the logistics of the financing dialogue meetings, the delegation from Brazil cautioned the board not to move too quickly, reminding members that the WHA is the “most important” decision-making authority. Assuming it would “stamp” the recommendations made by the Executive Board would be a “dangerous precedent”.

Outside of the session, a delegate from an EU country said that while there seemed to be consensus around the idea of a financing dialogue, “We just want to ensure that the reform is member-driven throughout the entire process.”

Frequenting with Partners

In a discussion zeroing in on WHO’s relationship with external partners, the sanctity of the organisation’s independence was also highlighted. On 25 January, members discussed arrangements for hosting health partnerships and a policy paper on engagement with non-governmental organisations.

During last year’s WHA, the modalities of improving the organisation’s involvement with WHO partnerships, including Roll Back Malaria and Stop TB partnerships, was discussed as part of the reform agenda. According the partnerships report, “Member States have suggested that the governing bodies define and play a stronger oversight role in this regard.”

Proposed actions for board consideration are related to strengthening the WHO’s role in the evaluation of partnerships and the ability to modify elements of these relationships.

While countries emphasised the importance of recognising “the excellent and important work by partnerships to public health,” many agreed that strengthening surveillance of the relationships was key.

The delegation from Brazil called the report a “sound proposal” and said “hosted partnerships must be looked at carefully to steer clear of conflicts of interest” and that there was a need to examine “interests within institutions”.

In an intervention [doc] made on behalf of the EU, the delegate from Lithuania underlined risks related to potential financial liabilities, seeking the confirmation that “all eight partnerships are no longer included in the Programme Budget 2014-2015”.

Policy on NGOs, Private Sector

Also requested by the 65th WHA, the policy paper looks at “key issues for the development of a policy on engagement with NGOs”. It was also requested that a draft policy paper be developed on “WHO’s relationships with private commercial entities.” This paper will be presented to the Executive Board in May.

One notion presented in the paper proved particularly divisive: the question on  “how best to proceed with the process of consultation for the development of WHO’s policy of engagement with non-governmental organizations, including the best means of harmonizing this policy with the development of WHO’s policy on relationships with private commercial entities.

Countries were divided as to whether or not the WHO should have a single policy governing relationships with external partners or if the there should be distinct policies to govern NGOs and companies separately.

The delegate from the UK was for a single policy, saying in an intervention, “We need an agreed and common state of principles, regardless of which sector they come from,” the official said. “We suggest synthesising the NGO and private sector papers, which could be a policy paper that could be applied to all actors.”

Industry was also supportive of an overarching approach. During an intervention [pdf], the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said, “We encourage Member States to take pragmatic approaches that reflect in equitable manner the value to global health that each of the NGOs, broadly speaking, non-state actors, brings – be it a patient or consumer group, an industry association, a disease-specific NGO, or a professional association.”

However, several countries, especially from the Latin American region, voiced their strong concerns about a single policy.

“We are quite clear that the WHO has to be very careful and have a very clear policy and separate quite clearly which are the NGOs which are for profit and which are the NGOs not for profit and other enterprises,” commented the delegate from Ecuador following the session.

“There is a fundamental difference between non-profit NGOs working in public health and the private for profit sector,” said Germán Velásquez of the intergovernmental South Centre in an interview with Intellectual Property Watch. He is attending this Executive Board as an advisor to some Latin American countries.

“For example, Médecins Sans Frontières (MSF, Doctors without Borders) could contribute its field expertise to a WHO expert committee developing policy guidelines addressing HIV/AIDS issues, however, a pharmaceutical company who produces antiretroviral drugs could not be part of an expert committee developing policy guidance,” Velásquez said.

Medicus Mundi, an international network of organisations working in the field of health advocacy, asked during its intervention why “references to policies aimed at dealing with the ‘private not-for-profit sector’ are no longer present in the documents dealing with the WHO reform.”

The 132nd Executive Board will continue deliberating on reform action points through 29 January to make recommendations for the World Health Assembly’s decision next May.

NGO Applicant Under Fire

Separately, the Standing Committee on NGOs met in a closed-door meeting this week to review the applications of organisations requesting NGO official status with WHO.

The International Baby Food Action Network (IBFAN) issued a “stark warning” about one of the applicants called the Global Alliance for Improved Nutrition (GAIN).  According to IBFAN’s press release, “GAIN is a new type of public private entity which works to open up markets for its 600 partner companies (including Danone the world’s largest baby food company, Mars, Pepsi, and Coca Cola).”

“IBFAN is concerned and has evidence that GAIN is actively undermining governments’ attempts to implement WHA Resolutions on infant and young child feeding,” the press release stated.

For the network, this application exemplifies the need for the WHO to develop “a comprehensive policy on conflicts of interest with criteria that distinguishes between bodies with a commercial interest in WHO policies and those who do not.”

A representative from GAIN could not be reached to comment at the time of publication.

According to sources, the Standing Committee’s decision on GAIN’s status is still pending.

The WHO Executive Board is meeting from 21-29 January (IPW, WHO, 21 January 2013).

Rachel Marusak Hermann may be reached at

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