WHO Executive Board Opens With Overcrowded Agenda; Chan Calls For Focus

The World Health Organization Executive Board opened this morning with a packed agenda, which prompted the chair to warn participants to restrict their statements. Director General Margaret Chan described as problematic the temptation to address all public health issues, and encouraged member states to focus on strategic and selective goals. Member countries also expressed concerns about the length of the agenda.

The 134^th WHO Executive Board (EB) is meeting from 20-25 January. The EB is expected to decide on the agenda of the next annual World Health Assembly in May. According to the WHO, “the main functions of the Board are to give effect to the decisions and policies of the Health Assembly, to advise it and generally to facilitate its work.” It includes 34 members, which are elected for three-year terms.

The EB documents are here.

At the outset of the meeting, EB Chair Jane Halton, secretary of the Australian Department of Health and Ageing, and responsible for Australia’s national health system, noted that a large number of people had showed up to observe and participate in this session of the EB.

Halton said that the agenda [pdf] is more crowded than ever before, which could challenge the ability to go through all items by the scheduled conclusion on Saturday noon, and would items showing later on the agenda at a disadvantage.

Two agenda items were approved and added. One is a proposal [pdf] from Finland on “Contributing to social and economic development: sustainable action across sectors to improve health and health equity.” The other one is a proposal [pdf] from Brazil on “Follow-up of the Recife Political Declaration on Human Resources for Health: renewed commitments towards universal health coverage.” Lebanon, although supportive of the proposals, remarked that the agenda already included close to 70 items and 17 resolutions and it would already be difficult to discuss all items, even with night sessions, which should be taken into account for future sessions. This was also noted in several countries’ opening statements.

The chair proposed that the issue of the length of the agenda be discussed later in the week.

In opening statements, countries said universal coverage and reform of the WHO are key priorities.

This week, there are a number of issues of interest from an intellectual property and innovation standpoint, as well as a key issue of how the UN organisation should handle its relationship with non-state actors (IPW, WHO, 18 January 2014).

Chan: Focus Brings Better Results

Chan said, in her opening statement, that this session of the EB shows a record-breaking number of participants as well as the largest number “by far” of items on the agenda for a non-budgetary year. She interpreted the high participation and the crowded agenda as a sign of interest in global health and the diversity of concerns.

She also said it showed “some measure of confidence that WHO is the right agency” to address public health concerns.

However, she noted the WHO “must be strategic and highly selective in the work it undertakes” rather than dilute efforts. “It is an easy trap to fall into, and it is dangerous,” she said. “If this happens, WHO will have a lot to say, but very little to show, especially in terms of health outcomes in your countries” she added.

She said one of the reasons for the success of the Millennium Development Goals is their limited number. She added that the 12th General Programme of Work, approved by member states last May, includes six leadership priorities.

WHO and its member states “must resist the temptation to cover every issue in the vast domain of public health,” she said. Demands on WHO and health ministries are rising under the combined effect of the increase of non communicable diseases increase, population aging, crowded cities and climate change, she said.

She also underlined the rising cost of health care and the unaffordability of new medicines and medical devices, even for the wealthiest countries.

“In recent years, the Health Assembly has approved a number of global strategies and action plans for addressing specific diseases or needs. This is good. All have clearly defined objectives, targets, and indicators, and this helps ensure that countries and their partners align activities in a tightly focused and coordinated way,” she said. However, a large number of health initiatives and actors “has led to fragmentation, duplication of efforts, high transaction costs, and heavy reporting and monitoring requirements for countries.”

In particular, she noted that many countries do not have the resources to produce data to monitor indicators, such as those needed for the global monitoring framework and targets for the prevention and control of noncommunicable diseases. According to WHO estimates, she said, only 81 out of the 194 WHO member countries regularly submit useable death registration data.

“We should be ambitious with these strategies and plans, but also pragmatic and realistic,” she said, adding that capacities of countries should be built but not overburdened.

She also noted that for medicines, only about 20 percent of member states have a well-functioning regulatory authority, 50 percent of them have variable regulatory quality and some 30 percent have very limited capacity.

Chan gave an account of progress in the WHO reform process. She said two financing dialogues have been held. These discussions, she said, “have included the identification of areas where resources can be used more efficiently and recommendations for some novel remedial actions that can help save money.”

“Further financing reforms aim to strengthen coordinated resource mobilisation at all levels of the organisation,” she added.

On performance, she said that to date WHO has prequalified more than 400 medical products, 62 last year. The WHO estimates, she said, that 97 percent of the global vaccine supply is currently “of assured quality.”

“Any country, not matter how poor, can improve health if it really wants to,” she said, citing examples of eradications in some African countries, and underlining that India has not seen a case of polio for three years.